A recipe for excellence in health care: investigating the relationship between health literacy, self-efficacy, awareness, and health services’ use


  • Rocco Palumbo
  • Carmela Annarumma
  • Marco Musella
  • Paola Adinolfi




patient participation; health literacy; quality; self-efficacy; awareness; patient empowerment; patient involvement


Purpose of the paper: Health services’ quality relies on the patients’ ability to participate in the provision of care as co-creators of value. Among others, individual health literacy - i.e. the ability to access, understand, process and use health information for the purposes of health protection and promotion - is crucial to realize the full potential of patient involvement. This paper investigates the consequences of inadequate individual health literacy on self-efficacy perception and awareness of health-related issues, which are expected to affect the process of patient empowerment.

Methodology: A sample of 438 Italian patients was built. The Newest Vital Sign (NVS) was used to assess individual health literacy skills. 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 correlates of limited health literacy.

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

Practical implications: Inadequate health literacy is likely to prevent patient empowerment. Actually, it performs as a barrier to patient involvement in the provision of care. Policy makers should attach a specific health literacy concern to health policies intended to promote patient participation in the provision of care. 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 of the paper: Although 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 scientific knowledge on the issue, delving into the effects of limited health literacy on self-efficacy perceptions, awareness of health-related issues and health services’ use


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