Competent or confident? – Critical health literacy as predictor of health behaviours

Critical health literacy (CHL) is concerned the complex skills that enable and promote critical evaluation of health information and subsequent action. Although CHL is thought to enable and promote beneficial judgments and subsequent health behaviours, a recent scoping review by Færevaag et al. identified conceptual heterogeneity and few studies examining its behavioural impact. Additionally, Jagemann et al. recently reported a shift in literacy instruments – from skills and competence towards participants’ confidence in the handling of health information – suggesting that variability in concepts and instruments complicate reliable inferences about the impact of CHL. The aim of this ongoing cross-sectional study (N = 515 Norwegian young adults) is to compare the predictive value of two CHL measures — the competence-based Claim Evaluation Tool by Austvoll-Dahlgren et al. and the CHL items from the confidence-based All Aspects of Health Literacy Scale by Chinn and McCarthy (AAHLS) – for self-reported health behaviours such as alcohol consumption, exercise, and tobacco use. Although both instruments measure CHL and were expected to show similar associations, only a small correlation between measures was observed (r = .196, p < .001). In a preliminary regression model adjusted for sex and age, higher AAHLS scores predicted significantly reduced alcohol consumption (B = −0.208, SE = 0.085, β = −.110, t = −2.45, p = .015, 95% CI [−.374, −.041]), whereas Claim scores showed no such association (B = −0.001, p = .988). Our preliminary analyses indicate that albeit both instruments are asserted to measure CHL, they differ significantly in their prediction of health behaviours. Such a discrepancy implies that conclusions on impact of CHL may largely depend on what instrument is used.

Key messages

• Preliminary analyses suggest that measuring Critical health literacy as competencies versus confidence in managing health information produces significantly different predictions of health behaviours.

• Heterogeneity in Critical health literacy instruments and corresponding predictions may challenge the position of the construct as reliable predictor for health.