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Abstract

Concept mapping served as the starting point for the aim of capturing the comprehensive structure of the construct of ‘health literacy.’ Ideas about health literacy were generated by 99 experts and resulted in 105 statements that were subsequently organized by 27 experts in an unstructured card sorting. Multidimensional scaling was applied to the sorting data and a two and three-dimensional solution was computed. The three dimensional solution was used in subsequent cluster analysis and resulted in a concept map of nine “clusters”: (1) self-regulation, (2) self-perception, (3) proactive approach to health, (4) basic literacy and numeracy skills, (5) information appraisal, (6) information search, (7) health care system knowledge and acting, (8) communication and cooperation, and (9) beneficial personality traits. Subsequently, this concept map served as a starting point for developing a “qualitative” structural model of health literacy and a questionnaire for the measurement of health literacy. On the basis of questionnaire data, a “quantitative” structural model was created by first applying exploratory factor analyses (EFA) and then cross-validating the model with confirmatory factor analyses (CFA). Concept mapping proved to be a highly valuable tool for the process of model building up to translational research in the “real world”.

4. Conclusions

The current literature review was conducted with the aim of exploring how CM has been used in community-engaged research. There are several limitations that are worth noting. By only searching PubMed, Scopus, and Web of Science databases for peerreviewed literature we may have missed relevant articles from journals indexed in other databases. Exclusion of gray literature, such as organizational reports, could have resulted in missed relevant research. While our community engagement dichotomy was a useful tool for categorizing articles, not all the articles presented the same level of information about community and stakeholder engagement, and as a result, classification required a degree of subjectivity from the reviewers so it is possible that some articles may have been misclassified based on available information. Used in a participatory and community-engaged manner, CM promotes the multiple and diverse perspectives of all stakeholders throughout the research process. Without the inclusion of relevant community stakeholders in all steps of the CM process, research outcomes and resulting interventions may miss the contextual and cultural nuances of the community and as a result, the research is less likely to be of lasting benefit (Vaughn et al., 2013). Without community engagement, the sustainability of projects can become compromised and the external validity questionable. The inclusion of community in all steps of the CM process can strengthen the research and contribute to the long-term applicability and potential sustainability of the findings for the community.