The causal pathways linking health literacy to health outcomes.

OBJECTIVE To provide an evidence-based review of plausible causal pathways that could best explain well-established associations between limited health literacy and health outcomes.

METHODS Through analysis of current findings in medical and public health literature on health literacy we derived a conceptual causal model.

RESULTS Health literacy should be viewed as both a patient and a system phenomenon. Three distinct points along a continuum of health care are suggested to be influenced by health literacy: (1) access and utilization of health care, (2) patient-provider relationship, and (3) self-care.

CONCLUSIONS The conceptual model organizes what has been learned to date and underscores promising areas of future inquiry and intervention.