   

models. Interestingly, an HL model developed by

Passche-Orlow and Wolf21 describes possible
causal pathways between HL and health outcomes,
highlighting knowledge, self-efficacy, and beliefs
as mediating factors (Figure 1). Therefore, the
current review aims to investigate the impact of
HL on self-management skills, with reference to
the initial stages of behavioral change, as
described by the CSM, SCT, and TBP (i.e.,
disease-related knowledge, self-efficacy, and
attitudes and beliefs).

CausalPathwaysbetweenLimitedHealthLiteracyandHealthOutcomes

Occupation AccessandUtilizationofHealthCare

Employment
PatientFactors SystemFactors
Income Navigationskills Complexity
Self-efficacy Acutecareorientation
SocialSupport Perceivedbarriers Tiereddeliverymodel

Culture

Language Provider-PatientInteraction
Race/
Ethnicity
PatientFactors ProviderFactors
Education
Health Knowledge Communicationskills Health
Literacy Beliefs Teachingability Outcomes
Participationin Time
decisionmaking Patient-centeredcare
Age
Vision

SelfCare
Hearing

VerbalAbility PatientFactors ExtrinsicFactors

Motivation Supporttechnologies
Memory Problemsolving Massmedia
Self-efficacy Healtheducation
Reasoning Knowledge/skills Resources

21