🌱 Field Note: Navigation Health Literacy

Blog note: This is a new series called, Field Notes, which are seedling posts that focus on research topics of interest. The information listed here is a work in progress. Planted on February 16, 2025; Last updated April 26, 2026

As part of my Master of Public Health program, I've begun focusing on a research topic of interest. My current interest is in better understanding how we navigate the US health care system and the ways in which we engage with information throughout this process.

I recently came across the concept of Navigation Health Literacy (HL-NAV), which is an information health literacy concept that comes out of Europe and exists between personal health literacy and organizational health literacy. All of these forms of literacy focus on four main components of engaging with health information:

obtain/access/find
understand/comprehend
assess/appraise/evaluate
apply/use

Below is a growing list of resources I've consulted so far:

Definitions

Health Literacies

Health Literacy (historical definition): One of the very first cited definition* of health literacy goes back to 2000, when two librarians at the National Library of Medicine and two physicians put together a bibliography of sources on the topic of health literacy (Selden et al. 2000). That definition would later make its way into the seminal publication, "Health Literacy: A Prescription to End Confusion" by the Institute of Medicine (2004).

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Ratzan and Parker, 2000).

*This definition exists in the introduction of the report which is signed by the two physicians, but the bibliography was authored by them and two librarians. The report cites the two physicians, but not the librarians, unclear why that is since the bibliography's citation includes all four authors.

Health Literacy (~~all inclusive~~ integrated definition, public health focus) (Sørensen et al, 2012):

Health literacy is linked to literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course.

Parental Health Literacy: Coming soon...

Personal Health Literacy (Healthy People 2030):

...is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

Organizational health literacy (Healthy People 2030):

...is the degree to which organizations enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

Navigation Health Literacy (Griese et al. 2020):

...[P]eople’s knowledge, motivation and skills to access, understand, appraise and apply the information and communication in various forms necessary for navigating health care systems and services adequately to get the most suitable health care for oneself or related persons.

Navigation Health Literacy (Dadaczynski et al. 2021, p. 2):

Hence, based on the definition provided by Sørensen et al. (1), we understand navigation health literacy in the local context as the ability and motivation to find, understand, evaluate, and apply health-related information and services provided in or by organizations or professionals in a person’s vicinity (e.g., city, district, neighborhood).

Seminal Publications

Institute of Medicine (US) Committee on Health Literacy. (2004). What is health literacy? In L. Nielsen-Bohlman, A. M. Panzer, & D. A. Kindig (Eds.), Health literacy: A prescription to end confusion. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK216035/

Kickbusch, I., Wait, S., & Maag, D. (2005). Navigating health: The role of health literacy.

Rudd, R. E. (2007). Health literacy skills of US adults. American journal of health behavior, 31(1), S8-S18.

Selden, Catherine R.; Zorn, Marcia; Ratzan, Scott; Parker, Ruth M., compilers. (2000 February). Health literacy [bibliography online]. Bethesda (MD): National Library of Medicine (Current bibliographies in medicine; no. 2000-1). 479 citations from January 1989 through December 1999. Available from: http://www.nlm.nih.gov/pubs/cbm/hliteracy.html (Origin of health literacy definition in IOM report; page no longer available)

Articles of Interest

Champlin, S., & Mackert, M. (2016). Creating a screening measure of health literacy for the Health Information National Trends Survey. American Journal of Health Promotion, 30(4), 291-293. To be Read

Dadaczynski, K., Krah, V., Frank, D., Zügel-Hintz, E., & Pöhlmann, F. (2021). Promoting Navigation Health Literacy at the Intersection of Schools and Communities. Development of the Game-Based Intervention Nebolus. Frontiers in public health, 9, 752183. https://doi.org/10.3389/fpubh.2021.752183

de Buhr, E., & Tannen, A. (2020). Parental health literacy and health knowledge, behaviours and outcomes in children: a cross-sectional survey. BMC public health, 20(1), 1096. Cross-Sectional Study To be Read

Fields, B., Rodakowski, J., James, A. E., & Beach, S. (2018). Caregiver health literacy predicting healthcare communication and system navigation difficulty. Families, Systems, & Health, 36(4), 482. To be Read

Griese L, Berens EM, Nowak P, Pelikan JM, Schaeffer D. Challenges in Navigating the Health Care System: Development of an Instrument Measuring Navigation Health Literacy. International Journal of Environmental Research in Public Health. 2020 Aug 8;17(16):5731. doi: 10.3390/ijerph17165731. PMID: 32784395; PMCID: PMC7460304. Survey instrument

Griese, L., Finbråten, H. S., Francisco, R., De Gani, S. M., Griebler, R., Guttersrud, Ø., ... & Schaeffer, D. (2022). HLS19-NAV—validation of a new instrument measuring navigational health literacy in eight European countries. International journal of environmental research and public health, 19(21), 13863. Survey instrument Reading

Griese, L., Schaeffer, D., & Berens, E. M. (2023). Navigational health literacy among people with chronic illness. Chronic Illness, 19(1), 172-183. To be Read

Loignon, C., Dupéré, S., Fortin, M., Ramsden, V. R., & Truchon, K. (2018). Health literacy–engaging the community in the co-creation of meaningful health navigation services: a study protocol. BMC Health Services Research, 18(1), 505.

Perez, L., Morales, K. H., Klusaritz, H., Han, X., Huang, J., Rogers, M., ... & Apter, A. J. (2016). A health care navigation tool assesses asthma self-management and health literacy. Journal of Allergy and Clinical Immunology, 138(6), 1593-1599. Intervention To be Read

Rikard, R. V., Thompson, M. S., McKinney, J., & Beauchamp, A. (2016). Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL). BMC Public Health, 16(1), 975. To be Read

Schaeffer, D., Griese, L., de Arriaga, M. T., da Costa, A. S., Francisco, R., De Gani, S. M., ... & Vrdelja, M. (2021). Navigational health literacy. In International report on the methodology, results, and recommendations of the European health literacy population survey 2019-2021 (HLS19) of M-POHL (pp. 201-232). Austrian National Public Health Institute. To be Read

Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H; (HLS-EU) Consortium Health Literacy Project European. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012 Jan 25;12:80. doi: 10.1186/1471-2458-12-80. PMID: 22276600; PMCID: PMC3292515.

Tsai, T. I., Lee, S. Y. D., & Yu, W. R. (2018). Impact of a problem-based learning (PBL) health literacy program on immigrant Women’s health literacy, health empowerment, navigation efficacy, and health care utilization. Journal of health communication, 23(4), 340-349. Intervention To be Read

⤷ Reply to me on Bluesky