Expanding understandings of health literacy
Our findings suggest that standard understandings of health literacy – as a set of skills possessed by an individual [17] – may be influenced by relational factors in the care environment, and specifically, by the relationship with the decision coach. Our work has demonstrated the limitations of applying a normative approach to decision making in which decision makers are encouraged to arrive at health care decisions after a period of self-reflection and an introspective weighing of the personal preferences associated with various options. Instead, our study has demonstrated that participants often prefer to engage in a process of dialogue during which they have the opportunity to articulate the factors underlying their decision making. This dialogue,facilitated by a decision coach, can lead to more collaborative and meaningful discussions and better support decision making solutions that are founded on greater health literacy skills. While our findings show promise for the potential use of SDM tools and approaches for use by and with Aboriginal women, they also suggest that health literacy models may require further examination and expansion.For example, there are other models that have also been developed to understand Aboriginal literacy, such as that of the Rainbow approach [50]; however, the emphasis on
health literacy, as opposed to literacy in general, was found to be of particular relevance in our study. Participants were found to be concerned with more than just having information communicated. They placed an emphasis on empowerment of the individual within a health care setting that systematically denied their equitable access to care due to underlying colonial forces. The adaptations to the OPDG and the decision coach may potentially disrupt colonial forces that are evident in health care systems and more accurately reflect the features of health literacy identified as relevant by users, in our case Aboriginal women.