Health literacy as a social practice: Social and empirical dimensions of knowledge on health and healthcare.

Health literacy has become a hot topic in health research and public health promotion. Most definitions specify health literacy as an individual cognitive skill, and surveys such as the EU-HLS which ask people to self-rate their decision-making capacity in the health system, grade a majority of the population as having an inadequate health literacy. Inspired by a praxeological understanding of knowledge and based on an empirical study on welfare bricolage in superdiverse urban neighborhoods, this paper explores health literacy ethnographically and highlights people's knowledge, creative practices and experiences concerning health and healthcare. It draws on 42 semi-structured interviews conducted with a highly diverse sample of residents in Bremen, Germany, between September 2015 and April 2017. The interviews were analyzed with the help of collaborative systematic thematic analysis. The findings question the individualistic and rationalistic bias of conventional approaches to health literacy and suggest that health literacy as a social practice is situational, multidimensional - comprised of different sources and forms of knowledge - and co-produced in social relations. This reformulation of the concept suggests that future research on health literacy should adopt a resource-oriented approach and embrace the rich variety of health knowledge practices.