Identifying the comprehensive framework and concept of Health literacy by qualitative synthesis

By the FMCH Editorial Office


Liu C, Wang D, Liu C, et al. What is the meaning of health literacy? A systematic review and qualitative synthesis. Family Medicine and Community Health 2020;8:e000351. doi: 10.1136/fmch-2020-000351


This study aimed to clarify what health literacy represents.


This study, applying a systematic review and qualitative synthesis of existing studies, found that health literacy is a multi-dimensional concept, defined as “ability of an individual to obtain and translate knowledge and information in order to maintain and improve health in a way that is appropriate to the individual and system contexts”. The concept covers three broad elements: (1) knowledge of health, health care and health systems; (2) processing and using information in various formats in relation to health and health care; (3) ability to maintain health through self-management and working in partnerships with health providers.


The newly proposed conceptual framework emphasizes the utmost goal of health literacy – promoting health, placing individual abilities under the context of health care systems involving families, communities and health care providers. It harmonizes the importance of information, knowledge, skills and capacities along the spectrum of health actions, which is comprehensive and explicit while still maintaining enough flexibility to adapt to various circumstances.

“Health literacy” was proposed as a term in the 1970s and has become a vibrant area of research in the first 10 years of 21 centuries. Its basic definition is “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”. Because its relationship with health outcomes and medical costs and the widespread lack of health literacy by residents, it attracted increasing attention from medical researchers. From this perspective, the research of health literacy is closely related with public health and population health tasks of general practitioners in primary care clinics.

However, there is a fundamental problem: the interpretations of health literacy are still unclear and inconsistent. Over 250 different definitions exist in the academic literature now. The confusion of this concept is likely to be a beerier of the research and practice development in this field. Therefore, the authors of this study conducted a qualitative synthesis research to identify the comprehensive framework and definition of “Health Literacy”. It is worth mentioning that, to our knowledge, this study may be the first qualitative synthesis study conducted by Chinese researchers in the field of “primary health care”.

Qualitative synthesis is a relative novel systematic review method. Differ from “meta-analysis” was generally considered a system review that statistically combines the results of quantitative studies to provide a more precise effect of the results; “qualitative synthesis” is a system review for integrating or comparing the findings from qualitative studies. It looks for‘themes’ or ‘constructs’ that lie in or across individual qualitative studies.

The authors searched PubMed, Medline, Embase, Web of Science, Scopus, PsycARTICLES and the Cochrane Library and restricted our search to articles published from 1 January 2010 to 15 March 2017. They reviewed the full-text of 569 studies. 34 articles were enrolled in this study. Based on comprehensive thematic analysis, they conceptualized a framework of “health literacy”: It is a set of knowledge, a set of skills or a hierarchy of functions, including “knowledge” (understanding information under the medical context, information in regard to health under everyday situations, information about the basic structure and available services of a health system, and fundamental scientific concepts and scientific arguments), “processing and using information” (ability to process and use information to guide health actions, self-efficacy in processing and using health information, provision of health information, and access to resources and support for processing information) and “ability to maintain health” (self-management and working in partnerships with health providers).

Based on this structure, the author defined the concept of “health literacy” as: the “ability of an individual to obtain and translate knowledge and information in order to maintain and improve health in a way that is appropriate to the individual and system contexts”. This finding constructed a theoretical basis in this field, which may be especially helpful for continued development and refinement of researches in this field.

Conflict of Interest:None declared


(Visited 137 times, 1 visits today)

Leave a Reply

Your email address will not be published. Required fields are marked *

Name *

This site uses Akismet to reduce spam. Learn how your comment data is processed.