Toward an interactional approach to health literacy

Health literacy (HL) concerns competencies that are necessary to access, understand, and use health information to solve a health problem. Existing methods for assessing HL (including e-health) are primarily based on self-reported data at the group or population level. This article takes an alternative position, focusing on how HL manifests and evolves interactionally in the clinical consultation setting between patients and health care professionals (HCPs). Sixteen clinical encounters with patients and nurses in the rheumatological department of a Norwegian hospital were video-recorded. The transcribed data were analyzed using theme-oriented discourse analysis, highlighting the following themes: understanding diagnosis, managing medication, giving information, accessing help, trusting the health care system, and accessing health information online. The findings show that the patient's HL manifests in different ways concerning these themes, depending on the co-participants' engagement with each other's initiatives or artefacts structuring the communication. An interactional perspective challenges the idea that HL is a static, measurable entity. HL assessment activities must address the dynamic dimensions that influence the patient's understanding of and applications of health information. These insights inform evaluation practices of HL in clinical encounters. More research is needed on how individuals' HL develops over time and is realized differently depending on the context and the relationships between their co-participants.