Purpose: The purpose of this paper is to discuss the changing patterns of users’ behavior in the health care service system. Although patient engagement and health services’ co-production are understood as essential ingredients in the recipe for sustainable health systems, some determinants to patient involvement are still widely neglected by both policy makers and health care professionals. Among others, inadequate health literacy performs as a significant barrier to patient empowerment. Design/methodology/approach: A survey aimed at objectively measuring health literacy-related skills was administered to a random sample of 600 Italian patients. The Italian version of the Newest Vital Sign (NVS) was used to assess the ability of the respondents to deal with written health information. Moreover, the respondents were asked to self-report their ability to navigate the health system. It was presumed that inadequate health literacy as measured by the NVS is related with impaired self-reported functional, interactive, and critical health-related competencies, paving the way for the inability and the unwillingness of patients to be involved in the health care provision. Findings: About half of the sample showed inadequate health literacy. However, poor NVS scores were only slightly associated with limited self-reported functional, interactive, and critical health-related competencies. In general, patients with inadequate health-related skills were not likely to be engaged in the provision of health services. Elderly, people suffering from financial deprivation and less educated individuals were found to be at special risk of living with limited health literacy. Practical implications: Limited health literacy is a common and relevant issue among people dealing with the health care service system. The impaired ability to collect, process, and use health information produces barriers to patient engagement and prevents the evolution of patients’ behavior toward health care co-production. Originality/value: Health literacy is a widely overlooked issue in the Italian national health system. This paper contributes in shedding light on the determinants and effects of health literacy of Italian hospital patients. Besides, some insights on the validity of the methodological tools typically used to assess health-related skills are provided.
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