Reconceptualizing Health Literacy to End Confusions: An Umbrella Review Research

The evolving definitions and interpretations of health literacy have created confusion, potentially hindering the development of effective interventions and policies. This umbrella review aimed to comprehensively evaluate systematic reviews (SRs) that provided definitions and conceptualizations of health literacy, with the goal of categorizing and clarifying the available information and eliminating inconsistencies.

This study followed the Joanna Briggs Institute (JBI) methodology for umbrella reviews. In July 2023, nine databases and two organizational websites were systematically searched. Based on predefined eligibility criteria, 14 SRs were identified for critical appraisal. Two researchers independently evaluated the methodological quality of each SR using the JBI checklist. In the critical appraisal process, low-quality SRs were excluded (n = 3). To minimize bias, data extraction was performed using the standard JBI tool. Data were analyzed thematically and synthesized based on a Braun and Clarke's thematic analysis method, utilizing an inductive approach.

Following the assessment process, 11 SRs were included in the study. Six studies redefined the concept of health literacy after the systematic review of the primary studies. Also, in four SRs, a theoretical framework or a conceptual model of health literacy had been presented. Based on the thematic analysis of 11 studies, various and numerous themes for health literacy (n = 360) were extracted and classified into 4 dimensions of Knowledge, Attitude, Practice, and Skills attributes, which makes deliverable health literacy definition and explanation in the form of KAPS framework. Also, three evolutional flows were inspirational and formable in tracking lifespan trends in health literacy: (1) Discipline-based explanation view, (2) Conceptual specification, and (3) Organizational perspective.

Our umbrella reviews redefined health literacy in line with public health discourse to inform future research and interventions. The resulting conceptual framework and the proposed definition could be practical and easy to use for health literacy research.