Skill set + mind set: Health literacy and activation as public health goals

Health literacy has dominated research agendas over the past two decades. Similarly, patient ‘activation' has increasingly become a variable of interest. While both may predict health outcomes, remediation strategies would significantly differ depending on which was the true cause of failure to adopt/change a specified health behavior. Using the NIH-funded ‘LitCog' Cohort study, the relationship between health literacy, patient activation, health behaviors, and clinical outcomes are investigated among a sample of older adults. Structured interviews were conducted among 1100 primary care patients ages 55 to 74 receiving care at one academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois. In addition to an extensive battery of demographic, socioeconomic, health behavior, health status indicators, both health literacy and patient activation were assessed. In multivariable analyses independent associations between health literacy and patient activation with health task performance, preventive services use, chronic disease outcomes, and quality of life were evaluated. Our findings demonstrate that both health literacy and patient activation significantly predict an array of health outcomes, while being conceptually and statistically distinct from one another. Yet the variance explained was greatest when both health literacy and activation were included compared to either alone. Achieving health behavior change and optimal clinical outcomes requires both improvement in patients' abilities (health literacy) and motivation (patient activation) directed at the intended goals. As such, interventions that solely rely on education/improved health communication, or persuasive techniques will likely fail without a well-integrated combination of both skill set and mind set.