Basic literacy and numeracy skills are therefore fundamental necessities for adequate health literacy, but they are not sufficient. Interactive health literacy – a person’s ability to be actively involved in decisions about their health and care over time, and in changing circumstances. Interactive health literacy is defined as people having more advanced cognitive and literacy skills, as well as confidence, and therefore being able to discuss and actively participate in their health and treatment options with health professionals.46 This also necessitates health systems removing all complexity and barriers to access, engagement and understanding. Interactive health literacy is believed to enable people to be actively involved in decisions about their healthcare over time and indemands of healthcare settings.29 A well-educated and literate person can have low health literacy when required to understand and act upon unfamiliar terminology and concepts in unfamiliar healthcare settings47 and when navigating health information online,48 especially when illness makes them more vulnerable.