In this paper we define health literacy and patient activation, discuss how each construct is measured, and review the evidence linking each construct to outcomes. Studies indicate that health literacy and patient activation are separate concepts that are only moderately correlated with each other. The studies indicate that patient activation and health literacy can each make independent contributions to outcomes. This is important, as it indicates the need to attend to both health literacy and patient activation in the design of interventions. This means that interventions that are successful in increasing health literacy will not necessarily also influence patient activation, and interventions that are successful in increasing patient activation will not necessarily also influence health literacy. Both are likely necessary. The studies show that patient activation is often a stronger predictor of behaviors and health outcomes than is health literacy, however, health literacy is sometimes a stronger predictor of understanding and using information for choice. Some of the differences observed in these studies reflect the fact that health literacy is primarily a skills based concept, and patient activation includes skills, but also includes confidence, beliefs, and role expectations. These differences suggest different pathways for effectively intervening to improve outcomes. The implications for interventions and research directions are discussed.
Keywords: Patient activation; health behaviors; health literacy; patient engagement; shared decision making.