Assignment: Geriatric Depression

Overall our measure had good internal consistency, though this fell below adequacy for the critical health literacy items, highlighting the challenges in identifying common overall competencies and appropriate measures in this area. Further factor analysis suggests that at least two underlying constructs

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which might underlie critical health literacy, namely ‘‘information appraisal’’ skills and ‘‘individual autonomy’’ regarding health care. This factor encompassed willingness to assert personal control over healthcare decisions and a positive view about the possibili- ties of individual contributions to community health outcomes, in line with aspects of Zimmerman’s concept of ‘‘psychological empowerment’’ [46].

The associations between scores on the subscales and various individual characteristics described above suggest that health providers should take care in making assumptions about the health literacy competencies of different community members. We did find an association between age, BME status and education level and difficulties with different aspects of health literacy, though these relationships were complex and not always in line with the more blanket assertions prompted by other research looking at these relationships which have used functional literacy assess- ment only [53,54].