In the United States, only 12% of adults possess the health literacy skills necessary to manage the complex health care system. When assessing a population, nurses must evaluate health literacy across which three levels?

Health literacy is assessed across three recognized levels in public health and nursing practice: functional, interactive, and critical. Functional health literacy refers to the basic reading and writing skills needed to understand health information in everyday situations, such as reading a prescription label or a discharge instruction sheet. Interactive health literacy goes further, involving the cognitive and social skills needed to actively participate in healthcare encounters, extract information from different sources, and apply it to changing circumstances. Critical health literacy represents the most advanced level, encompassing the ability to critically analyze health information, understand social and political determinants of health, and take action to address them at a community or policy level. This three-tier model was developed by Nutbeam and has been widely adopted in public health curricula. Primary, secondary, and tertiary describes levels of prevention or healthcare delivery, not literacy. Cognitive, affective, and psychomotor are Bloom's domains of learning objectives, unrelated to literacy levels. Personal, organizational, and societal describes a social-ecological framework but does not correspond to the established health literacy classification system. Nurses must assess literacy across all three levels to tailor education, communication, and advocacy strategies appropriately.