Health Literacy as a Pathway to Promoting the Health of Young Adults

Monday, 23 July 2018: 10:00 AM

Julie M. Shaw, MPH, BAppSc (Nsg), RN
Anthony Joseph Welch, PhD
Moira Jane Williamson, PhD
School of Nursing, Midwifery and Social Sciences, Central Queensland University, Noosaville, Australia


Nurses are integral to the health literacy of individuals and populations as nurses promote health and are in direct contact with those individuals accessing and using health services (Bauer, 2011). To be able to support individuals in the management of their health it is important that nurses understand, and are able to apply their understanding of health literacy to the delivery of nursing care to individuals and populations (Johnson, 2015).

Health literacy is a concept that was initially explored by health professionals in the 1990s, to provide insight into the health behaviour and health outcomes of individuals, in particular non-compliance with prescribed treatment (Parker, Baker, Williams & Nurss, 1995). The concept was then explored from the health promotion perspective (Nutbeam, 2000; Ratzan, 2001; Kickbusch, Wait, Maag, McGuire, & Banks, 2005) with Nutbeam (2008) providing an analysis of the two perspectives resulting in health literacy being seen as either as an asset or a risk for the individual’s health. There is now a deeper and clearer understanding of the concept (Sorensen et al., 2012) with the World Health Organisation (2015) defining health literacy as ‘the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health’ (Health information sheet 1, para 2).

Measures of health literacy have also been undertaken in an effort to indicate the most effective health care provider information and activities that best suit the individual health consumer in the delivery of health services (Osborne et al., 2013; Sand-Jecklin, & Coyle, 2014). There is a need to not only consider the health literacy skills of the client, but also the quality, format and language of the information provided so that it is readily accessible easily understood by the lay person.

While health literacy is widely accepted as a health determinant (Kickbusch, 2001; Yin et al., 2012), there has been limited investigation of health literacy from the consumer’s perspective. The aim of this study was to identify, describe and explain how young adults (18-24 years) enact health literacy from the perspective of the young adult and in doing so inform the promotion of young adult health incorporating the delivery of health information and services for young adults by health professionals, in particular nurses.


Constructive grounded theory, an accepted qualitative method used to explore the social behaviour of different groups (Charmaz, 2014), was the method used in this study. Data was collected via semi-structured individual and group interviews. Sampling was initially purposive followed by a theoretical approach with twelve young adults (males n = 8; females n = 4), from across the education and socioeconomic spectrums in eastern Australia, participated in the study. In accordance with constructive grounded theory, data collection, coding and analysis were carried out concurrently with data collection ceasing on data saturation (Birks & Mills, 2015).


A theory of Young Adult Health Literacy was constructed providing an abstract representation of study participants’ enactment of health literacy. The model is comprised of five components -1. My Health – the core component incorporates the young adult’s perception of being healthy and unhealthy; 2. Learning about Health – represents knowledge acquisition by the young adult via formal, vicarious and experiential learning; 3. Developing Meaningful Knowledge – symbolises young adults purposely seeking health information on health and health services allowing for variance in sources of information, information sought and the validation and trust of that information; 4. Making Health Decisions – sees the young adult empowered to manage their health acknowledging that this will be affected by the young adult’s a) beliefs on managing health b) maintenance of health; and c) access and use of health services; 5. Context- represents the dynamics of daily living for young adults affected by the competing life demands of young adults -work, study, leisure and relationships. The model demonstrates how each component is integral to health literacy, allows for variance in young adult knowledge, skills and abilities with the multi layering of the model signifying the interdependence of components. These components provide the opportunity for nurses to support young adults in the management of their health.


The Young Adult Health Literacy theory provides an understanding of the health literacy of a small group of young adults hence has limitations. The theory however, can now be tested in the young adult as well as other populations; and identifies opportunities for health professionals, in particular nurses, as well as health services to promote young adult health literacy and health over the spectrum of the young adult’s life within the various contexts of health care that is, acute nursing care, community nursing care, health promotion and public health.