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.