Critical Health Literacy and health behaviours. – Insights from a scoping review

CHL is posited to facilitate health behaviours, but we found variable support for this assertion. This may have serious implications for future research, and health communication and -policies.

The unprecedented availability of information, misinformation, and disinformation about health online signifies the need for users to critically appraise information. One example is during the SARS Covid-19 pandemic, in which the corresponding “infodemic” complicated individual and collective health behaviours and decisions. Therefore, the ability to critically appraise health information online is essential both in everyday life, and especially during disease outbreaks.

Critical health literacy (CHL) is believed to enable such appraisal and behaviours. It encompasses relevant knowledge and skills related to health which may empower citizens, enabling beneficial judgments and subsequent health behaviours. CHL has consequently received increasing research focus and -interest, partially due to its relevance during infodemics. However, few studies have examined whether CHL predicts health behaviours, and no review exists on this topic. Therefore, we conducted a scoping review to investigate what currently is known about the association between CHL and health behaviours, defined by Nutbeam and Kickbusch (1998) as activities aimed at promoting, protecting, or maintaining health.

From our literature search, we identified 376 papers, 167 of which were eligible for review. Of these, only 13 investigated the association between CHL and health behaviours in the general population. Our results indicated that studies typically found support for one or more health behavioural associations with higher levels of CHL. However, results are not univocal; we observed that some studies found the opposite, that CHL predicts a deterioration of associated health behaviours.

Three of the 13 studies found CHL to predict health behaviour deterioration, two of which reported significantly reduced vaccine compliance among high CHL individuals. Specifically, we observed that studies who found CHL to predict reduced health behaviours were related to situations involving trust and adherence to authority. This indicates that more research is needed to understand the complex interplay between trust and critical appraisal on behavioural adherence to health authorities.

CHL is posited to facilitate health behaviours, but we found variable support for this assertion. This may have serious implications for future research, and health communication and -policies.