Psychological and Cognitive Determinants of the Health Literacy on Soon-To-Be-Aged and Older Adults: a Systematic Review

Michael Huen-Sum Lam*, Angela Yee-Man Leung**, Sophia Siu-Chee Chan***
* PhD Student, School of Nursing, The University of Hong Kong.
** Assistant Professor, School of Nursing, The University of Hong Kong.
*** Professor, School of Nursing, The University of Hong Kong.
Periodicity:May - July'2011


The purpose of this study is to provide an evidence-based review of psychological and cognitive determinants of health literacy (HL) on soon-to-be-aged and older adults. HL is considered by the Office of Surgeon General of United States Department of Health and Human Services as one of the four public health priorities. Some researchers advocated that limited HL is the first step on the pathways to poor health outcomes. However, systematic reviews on psychological and cognitive determinants of HL which affected the health outcomes are inadequate. Six academic electronic database for articles published from 1990 through 2010 were searched. The articles were limited to English language, full text and soon-to-be-aged and older adults aged 50 or over. The searching terms included health literacy, psychology, cognition, factor, association, relationship, soon-to-be-aged, older adult, geriatric etc. Nineteen articles met the inclusion criteria, most studies demonstrated the positive relationship between HL and psycho-determinants (self-efficacy; attitude or belief; perceptions; motivation and intention) and cognitive determinants (cognitive function). Most of the psychological and cognitive determinants of Paasche-Orlow and Wolf’s model related to HL in this review. Three plausible theories explaining the mechanism between HL and health outcomes were suggested.


Soon-To-Be-Aged, Older Adults, Health Literacy, Psychological Determinants, Cognitive Determinants, Systematic Review

How to Cite this Article?

Lam, M.H., Leung, A.Y., and Chan, S.S. (2012). Psychological and Cognitive Determinants of the Health Literacy on Soon-To-Be-Aged and Older Adults: a Systematic Review. i-manager’s Journal on Nursing, 1(2), 46-56.


[1]. Baker, D. W. (1999). Reading between the lines: deciphering the connections between literacy and health. J Gen Intern Med, 14(5), 315-317.
[2]. Baker, D. W., Gazmararian, J. A., Sudano, J., & Patterson, M. (2000). The association between age and health literacy among elderly persons. J Gerontol B Psychol Sci Soc Sci, 55(6), 368-374.
[3]. Baker, D. W., Gazmararian, J. A., Sudano, J., Patterson, M., Parker, R. M., & Williams, M. V. (2002). Health literacy and performance on the Mini-Mental State Examination. Aging MentHealth,6(1),22-29.doi : 10.1080/13607860120101121.
[4]. Baker, D. W., Wolf, M. S., Feinglass, J., & Thompson, J. A. (2008). Health literacy, cognitive abilities, and mortality among elderly persons. J Gen Intern Med, 23(6), 723-726. doi: 10.1007/s11606-008-0566-4.
[5]. Baker, D. W., Wolf, M. S., Feinglass, J., Thompson, J. A., Gazmararian, J. A., & Huang, J. (2007). Health literacy and mortality among elderly persons. Arch Intern Med, 167(14), 1503-1509. doi: 10.1001/archinte.167.14.1503.
[6]. Bandura, A. (1989). Human agency in social cognitive theory. Am Psychol, 44(9), 1175-1184.
[7]. Berkman, N.D., DeWalt, D.A., Pignone, M.P., Sheridan, S.L., Lohr, K.N., Lux, L., & et al. (2004). Literacy and Health Outcomes. Rockville, MD: RTI International-University of North Carolina Evidence-Based Practice Center.
[8]. Champion, V. L., & Skinner, C. S. (2008). The Health Belief Model. In K. Glanz, B. K. Rimer & K. Viswanath (Eds.), Health Behavior and Health education (fourth ed., pp. 45- 65). San Francisco: Jossey-Bass.
[9]. Cutilli, C. C. (2007). Health literacy in geriatric patients: An integrative review of the literature. Orthopaedic Nursing, 26(1), 43-48.
[10]. Davis, T. C., Arnold, C., Berkel, H. J., Nandy, I., Jackson, R. H., & Glass, J. (1996). Knowledge and attitude on screening mammography among low-literate, lowincome women. Cancer, 78(9), 1912-1920.
[11]. Davis, T. C., Long, S. W., Jackson, R. H., Mayeaux, E. J., George, R. B., Murphy, P. W., & Crouch, M. A. (1993). Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med, 25(6), 391-395.
[12]. DeWalt, D. A., & Hink, A. (2009). Health literacy and child health outcomes: a systematic review of the literature. Pediatrics, 124 Suppl 3, S265-274. doi: 10.1542/peds.2009-1162B.
[13]. DeWalt, D. A., & Pignone, M. P. (2005). Reading is fundamental: the relationship between literacy and health. ArchInternMed,165(17),1943-1944.doi : 10.1001/archinte.165.17.1943.
[14]. DeWalt, D. A., Boone, R. S., & Pignone, M. P. (2007). Literacy and its relationship with self-efficacy, trust, and participation in medical decision making. Am J Health Behav , 31Suppl1,S27-35.doi : 10.5555/ajhb.2007.31.supp.S27.
[15]. Dolan, N. C., Ferreira, M. R., Davis, T. C., Fitzgibbon, M. L., Rademaker, A., Liu, D., Bennett, C. L. (2004). Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference? J Clin Oncol, 22(13), 2617-2622. doi: 10.1200/jco.2004.10.149.
[16]. Fallowfield, L., & Jenkins, V. (1999). Effective communication skills are the key to good cancer care. Eur J Cancer, 35(11), 1592-1597.
[17]. Federman, A. D., Sano, M., Wolf, M. S., Siu, A. L., & Halm, E. A. (2009). Health literacy and cognitive performance in older adults. J Am Geriatr Soc, 57(8), 1475- 1480. doi: 10.1111/j.1532-5415.2009.02347.x.
[18]. Friedman, D. B., Corwin, S. J., Dominick, G. M., & Rose, I. D. (2009). African American men's understanding and perceptions about prostate cancer: why multiple dimensions of health literacy are important in cancer communication. J Community Health, 34(5), 449-460. doi: 10.1007/s10900-009-9167-3.
[19]. Galson, S. (2008). Minutes of the Board of Regents, Department of Health and Human Services National Institutes of Health, National Library of Medicine. Retrieved March 7, 2011, from 08bor.pdf.
[20]. Gerber, B. S., Brodsky, I. G., Lawless, K. A., Smolin, L. I., Arozullah, A. M., Smith, E. V., Eiser, A. R. (2005). Implementation and evaluation of a low-literacy diabetes education computer multimedia application. Diabetes Care, 28(7), 1574-1580.
[21]. Greene, M. G., Adelman, R. D., Charon, R., & Friedmann, E. (1989). Concordance between physicians and their older and younger patients in the primary care medical encounter. Gerontologist, 29(6), 808-813.
[22]. Guerra, C. E., Krumholz, M., & Shea, J. A. (2005). Literacy and knowledge, attitudes and behavior about mammography in Latinas. J Health Care Poor Under served,16(1),152-166.doi : 10.1353/hpu.2005.0012.
[23]. Institute of Medicine. (2004). Health Literacy: A Prescription to End Confusion. Washington, DC: National Academic Press.
[24]. Ishikawa, H., Takeuchi, T., & Yano, E. (2008). Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care, 31(5), 874-879. doi: 10.2337/dc07-1932.
[25]. Kim, S. H., & Yu, X. (2010). The mediating effect of selfefficacy on the relationship between health literacy and health status in Korean older adults: a short report. Aging Ment Health,14(7),870-873.doi : 10.1080/13607861003801011.
[26]. Levinthal, B. R., Morrow, D. G., Tu, W., Wu, J., & Murray, M. D. (2008). Cognition and health literacy in patients with hypertension. J Gen Intern Med, 23(8), 1172-1176. doi: 10.1007/s11606-008-0612-2.
[27]. Lillie, S. E., Brewer, N. T., O'Neill, S. C., Morrill, E. F., Dees, E. C., Carey, L. A., & Rimer, B. K. (2007). Retention and use of breast cancer recurrence risk information from genomic tests: the role of health literacy. Cancer Epidemiol Biomarkers Prev, 16(2), 249-255. doi: 10.1158/1055- 9965.epi-06-0525.
[28]. Malle, B., & Knobe, J. (1997). The folk concept of intentionality. Journal of Experimental Social Psychology, 33, 101-121.
[29]. Miller, L. M., Gibson, T. N., & Applegate, E. A. (2010). Predictors of nutrition information comprehension in adulthood. Patient Educ Couns, 80(1), 107-112. doi: 10.1016/j.pec.2009.09.031.
[30]. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 8(5), 336- 341. doi: 10.1016/j.ijsu.2010.02.007.
[31]. Morrow, D., Clark, D., Tu, W., Wu, J., Weiner, M., Steinley, D., & Murray, M. D. (2006). Correlates of health literacy in patients with chronic heart failure. Gerontologist, 46(5), 669-676.
[32]. Osborn, C. Y., Cavanaugh, K., Wallston, K. A., & Rothman, R. L. (2010). Self-efficacy links health literacy and numeracy to glycemic control. J Health Commun, 15 Suppl 2, 146-158. doi: 10.1080/10810730.2010.499980.
[33]. Osborn, C. Y., Paasche-Orlow, M. K., Bailey, S. C., & Wolf, M. S. (2011). The mechanisms linking health literacy to behavior and health status. American Journal of Health Behavior, 35(1), 118-128.
[34]. Paasche-Orlow, M. K., & Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. American Journal of Health Behavior, 31 Suppl 1, S19-26. doi: 10.5555/ajhb.2007.31.supp.S19.
[35]. Paasche-Orlow, M. K., Parker, R. M., Gazmararian, J. A., Nielsen-Bohlman, L. T., & Rudd, R. R. (2005). The prevalence of limited health literacy. J Gen Intern Med, 20(2), 175-184. doi: 10.1111/j.1525-1497.2005.40245.x.
[36]. Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med, 10(10), 537-541.
[37]. Peterson, N. B., Dwyer, K. A., Mulvaney, S. A., Dietrich, M. S., & Rothman, R. L. (2007). The influence of health literacy on colorectal cancer screening knowledge, beliefs and behavior. J Natl Med Assoc, 99(10), 1105-1112.
[38]. Pignone, M. P., & DeWalt, D. A. (2006). Literacy and health outcomes: is adherence the missing link? J Gen Intern Med, 21(8), 896-897. doi: 10.1111/j.1525- 1497.2006.00545.x.
[39]. Plotnikoff, R. C., Johnson, S. T., Luchak, M., Pollock, C., Holt, N. L., Leahy, A., Boule, N. G. (2010). Peer telephone counseling for adults with type 2 diabetes mellitus: a casestudy approach to inform the design, development, and evaluation of programs targeting physical activity. Diabetes Educ, 36(5) , 717-729.doi : 10.1177/0145721710376327.
[40]. Powell, C. K., Hill, E. G., & Clancy, D. E. (2007). The relationship between health literacy and diabetes knowledge and readiness to take health actions. Diabetes Educ, 33(1), 144-151. doi: 10.1177/0145721706297452.
[41]. Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol, 55(1), 68-78.
[42]. Sarkar, U., Fisher, L., & Schillinger, D. (2006). Is selfefficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care, 29(4), 823-829.
[43]. Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. JAMA, 288(4), 475-482.
[44]. Stewart, M. A. (1995). Effective physician-patient communication and health outcomes: a review. CMAJ, 152(9), 1423-1433.
[45]. Torres, R. Y., & Marks, R. (2009). Relationships among health literacy, knowledge about hormone therapy, selfefficacy, and decision-making among postmenopausal health. J Health Commun, 14(1), 43-55. doi: 10.1080/10810730802592247.
[46]. United States Department of Health and Human Services (USDHHS), Office of Disease Prevention and Health Promotion. (2005). Healthy People 2010. Retrieve on August 2, 2007 from the web healthypeople.
[47]. von Wagner, C., Semmler, C., Good, A., & Wardle, J. (2009). Health literacy and self-efficacy for participating in colorectal cancer screening: The role of information processing. Patient Educ Couns, 75(3), 352-357. doi: 10.1016/j.pec.2009.03.015.
[48]. Wellman, H. M., & Woolley, J. D. (1990). From simple desires to ordinary beliefs: the early development of everyday psychology. Cognition, 35(3), 245-275.
[49]. Wolf, M. S., Gazmararian, J. A., & Baker, D. W. (2005). Health literacy and functional health status among older adults. Arch Intern Med, 165(17), 1946-1952. doi: 10.1001/archinte.165.17.1946.

Purchase Instant Access

Single Article

North Americas,UK,
Middle East,Europe
India Rest of world
Pdf 35 35 200 20
Online 35 35 200 15
Pdf & Online 35 35 400 25

If you have access to this article please login to view the article or kindly login to purchase the article
Options for accessing this content:
  • If you would like institutional access to this content, please recommend the title to your librarian.
    Library Recommendation Form
  • If you already have i-manager's user account: Login above and proceed to purchase the article.
  • New Users: Please register, then proceed to purchase the article.