Assignment: Collaborative Spiritual Care Conversations

A review of existing measures and a wider exploration of the literature on patient communication skills suggested that Nut- beam’s category of communicative health literacy could be separated into two components: information gathering and processing skills, and interactive skills needed for successful consultations with health providers. We adapted items from Ishikawa et al.’s self-report items relating to information gathering aspects of communicative health literacy [35] into a single item to assess patients’ willingness to access and use multiple sources of information about their health (‘Are you someone who likes to find out lots of different information about your health?’). Three further items (questions Com Q1–Com Q3 in Table 2) were developed from research identifying key patient communication skills, such as asking questions or requesting clarification, which have been found to improve satisfaction and outcomes from health con- sultations [36–39].

The definition of critical health literacy is also diffuse and requires clearer conceptualisation [40]. Existing research has focused on information appraisal [35,41,42], but Nutbeam’s definition suggests that this aspect of health literacy also involves taking a critical and reflexive stance vis-a-vis health information, considering issues of the relevance and reliability, and integrating knowledge of the social determinants of health and skills in community-level action [43]. To construct our seven critical health literacy items, we drew from existing research not only within the