A new health literacy model for limited english speaking immigrants

Health literacy (HL) is critical to effective communication between individuals and their health care providers. HL has become increasingly important globally with the emergence of chronic diseases, growing immigrant populations who speak little English, and the increasing emphasis on active patient involvement in their management of disease. Unfortunately, health literacy studies have seldom included immigrant populations. Immigrants experience declining health for a number of years upon immigration to their host country. The subsequent decline in health has been attributed to difficulties with settling, adjusting and integrating into the host country. Immigrants have difficulties adapting to the consumer model of health care, which incorporates the concepts of individual responsibility, autonomy and choice. In addition, understanding of health literacy is limited by the variability in the concept itself, and by the uncertainty about the mechanisms through which low health literacy leads to health disparities. Existing theoretical constructs provide a poor match to the variables measured by health literacy assessments, which have been criticized for their inability to capture complex concepts and relationships in terms of language, culture, communication, and technology. The objective of this review is to examine existing health literacy models and measures to assess their application to immigrant population with Limited English Proficiency in the context of information and communication technology. We proposed a new health literacy model that elucidates the causal pathway that links health literacy, health behaviors, and health outcomes. Our proposed constructs: source, context, process, and outcome provide a comprehensive and novel approach to study health literacy.