Date of Award


Publication Type

Master Thesis

Degree Name





health education, health literacy, health literacy assessments, healthcare environment, nursing, nursing leadership


Laurie Freeman




Health literacy (HL) is the ability to access and act on health-related information, as well as the ability to navigate through healthcare systems in order to maintain a healthy lifestyle. Health literacy assessments (HLA) are a direct measure of an individual’s ability to understand health related information using valid and reliable health literacy assessment tools. Objective: to explore the current state of HLA frequency use within the nursing profession in Ontario, as well as nurse’s perception of knowledge, skills, self-efficacy, and environmental influences surrounding their HLA practices. Methods: convergent mixed-method cross-sectional study utilizing an exploratory descriptive design. Results: Seventy-one Registered Nurses (RNs) from across Ontario from a variety of backgrounds and work settings participated in the study. Nurses in this sample performed HLA some of the time, lacked knowledge about the Canadian populations risk factors for limited HL, and felt they had the proper skills, some of the time, to do HLA. Environment had a significant impact along with leadership support, on the frequency in which participants informally assessed patients HL. Nurses also reported a higher level of self-efficacy for their perceived ability to perform HLA, yet they only performed them some of the time. Universal precautions use was the greatest predictor (p = 0.001) to increase the frequency of HLA performances. Conclusion: this is the first study of its kind in Canada, recommending that practicing nurses receive education and training in their work environments on HL and HLA. Adjustments should also be made to healthcare working environments in order to promote universal precaution use, leadership support, and develop policies and procedures to support nurses in HLA practice.