Realizing excellence in health care: The relationship between health literacy, self-efficacy, awareness and health services’ use

Rocco Palumbo, Carmela Annarumma, Marco Musella, Paola Adinolfi


Purpose. Health services’ quality strongly relies on the patients’ ability to participate in the provision of care and to perform as value co-creators. Among others, individual health literacy – that is to say the ability to access, understand, process and use health-related information for the purposes of health protection and promotion – is crucial to realize the full potential of patient involvement. This paper aims at investigating the consequences on problematic health literacy on both self-efficacy perception and awareness of health-related issues, which deeply affect the process of patient empowerment.

Methodology. A sample of 438 Italian patients was built. The Newest Vital Sign (NVS) tool was used to assess health literacy skills. In addition, a self-reporting survey was administered to assess the patients’ self-efficacy, awareness of health-related issues and health services’ use. Also, socio-demographic variables were collected to investigate the main correlates of limited health literacy.

Findings. Problematic health literacy was prevailing among the respondents. The lower the health literacy skills, the poorer the individual self-efficacy and the smaller the awareness of health-related issues. Also, inadequate health literacy was associated with increased access to emergency care and hospital services.

Practical implications. Inadequate health literacy is able to prevent patient empowerment. Indeed, it performs as a barrier to their involvement in the provision of care. Policy makers should attach a specific health literacy concern to health policies intended to promote patient empowerment. Besides, health care providers should arrange and implement tailored health literacy promotion initiatives, in an attempt to realize the full potential of patient empowerment and improve the quality of care.

Originality/value. Even though health literacy is a well-established topic, evidence on the consequences of limited health literacy on health behaviors is still inconsistent. This paper contributes in advancing the scientific knowledge, delving into the effects of limited health literacy on self-efficacy, awareness of health-related issues and health services’ use.


Health literacy; Quality; Self-efficacy; Awareness; Patient empowerment

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