Health literacy was first introduced in the 1970s in the United States and Canada and has since evolved globally as a concept and a field of research. The concept has also made its way onto the political agenda in many countries, as can be seen, for example, from the many national health literacy policies (Nutbeam, 2017). In the Nordic region, so far only Norway has a national strategy on health literacy.
Throughout the years, several definitions and conceptual models have been used to explain the concept of health literacy, partly because it has been employed in many different contexts (Sørensen et al., 2012). In the beginning, the focus was mainly on the ability to understand health information related to healthcare. Later the focus has broadened, and a paradigm shift has taken place. Today, health literacy generally focuses on several skills and competencies needed to access, understand, appraise, and apply health information that has to do with healthcare, disease prevention and health promotion.
In the 1998* health promotion glossary, the WHO defines health literacy as
"the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Health literacy implies the achievement of a level of knowledge, personal skills, and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions. Thus, health literacy means more than being able to read pamphlets and make appointments. By improving people’s access to health information, and their capacity to use it effectively, health literacy is critical to empowerment (WHO, 1998)."
In 2000, Nutbeam operationalised the WHO definition of health literacy and created a conceptual model operating on three levels of health literacy known as basic/functional, communicative/interactive, and critical health literacy. What started out as being a qualification of sufficient reading and writing skills, and with a basic knowledge of health (basic/functional health literacy), health literacy has evolved into a competence in the ability to perform knowledge-based literacy tasks to exert greater control over life events and situations (critical health literacy). A higher level of health literacy also leads to greater autonomy and personal empowerment (Nutbeam, 2000; Nutbeam, 2017).
Furthermore, different approaches and efforts are needed to meet the needs and skills of people at each level of health literacy. This applies, for example, to adapted information and media use, as there is no one-size model that fits all (Nutbeam, 2017). For many years, Nutbeam’s conceptual model was the most used in explaining the concept of health literacy.
*By the final review of this report, it became known that WHO had updated the health promotion glossary from 1998 and modified the definition of health literacy. In the new health promotion glossary of terms, WHO defines health literacy as representing
"the personal knowledge and competencies that accumulate through daily activities, social interactions and across generations. Personal knowledge and competencies are mediated by the organizational structures and availability of resources that enable people to access, understand, appraise, and use information and services in ways that promote and maintain good health and well-being for themselves and those around them (WHO, 2021)."