Beyond Reading and Understanding: Health Literacy as the Capacity to Act

Jany Rademakers*, Monique Heijmans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Many health literacy interventions have a limited focus on functional/cognitive skills. In psychosocial models, the capacity to act however is seen as a major driver of behavioural change. This aspect is often lacking in health literacy concepts. In this study, we examine the impact of both aspects of health literacy (functional/cognitive and capacity to act) on specific healthcare outcomes (healthcare use, experiences with patient-centered care, shared-decision making, and self-management). In a sample of a national panel of people with a chronic disease (NPCD), questions about health literacy, patient activation, and outcomes were asked. The results indicated that 39.9% had limited HL levels and 36.9% had a low activation score. Combined, 22.7% of the sample scored low on both aspects, whereas 45.8% had adequate levels on both. Patients who score low on both use more healthcare and have less positive experiences with patient-centered care, shared decision making, and self-management. Patients who have adequate competency levels in both respects have the best outcomes. Both cognitive and non-cognitive aspects of health literacy are important, and they enhance each other. The capacity to act is especially important for the extent to which people feel able to self-manage.
Original languageEnglish
Article number1676
Number of pages12
JournalInternational Journal of Environmental Research and Public Health
Issue number8
Publication statusPublished - 7 Aug 2018


  • health literacy
  • health determinants
  • health competencies
  • health outcomes
  • patient-centered care
  • definitions
  • conceptual models
  • CARE
  • Humans
  • Middle Aged
  • Male
  • Cognition
  • Self-Management
  • Young Adult
  • Netherlands
  • Adult
  • Female
  • Decision Making
  • Health Behavior
  • Health Literacy/statistics & numerical data
  • Aged
  • Patient Acceptance of Health Care/statistics & numerical data

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