Compensatory network capital: negative and ambivalent ties in the conversion of health literacy into action

Critical Health Literacy (CHL) emphasizes that health-related action is shaped by power, inequality and structural conditions, not by individual skills alone. This study examines a more specific and under-theorized link in that process: how negative and ambivalent social ties affect whether health-related competencies are enacted as concrete action in everyday healthcare. Drawing on 12 semi-structured interviews with adults living with multimorbidity in contexts of social vulnerability, the study explores how health-related knowledge, intentions, and professional advice are converted, delayed, redirected, or blocked in concrete health-related episodes. Analysis was abductive and used Compensatory Network Capital (CNC) as a sensitizing framework. Participants often described knowledge, motivation, and awareness of recommended care, but action appeared to be constrained when support was difficult to mobilize, poorly matched to the task, insufficiently recognized in institutional encounters, or when no helper was available to act on the person's behalf. These patterns were analysed through four tie-level mechanisms: Activation, Function-specific Help, Recognition and Substitution. Negative and ambivalent ties appeared to operate not only as psychosocial stressors but also as practical barriers affecting help-seeking, follow-up, care coordination and digital navigation. The study contributes to CHL research by specifying a micro-meso relational layer through which health-related competencies may become actionable, partial or blocked in practice. It suggests that equity-oriented health promotion may need to address not only individual skills, but also the relational and organizational conditions that enable, constrain or block health-related action.