Social science constructs as spheres of activity: Health literacy and communicative competence in dialogue

Abstract Healthcare spaces are “contact zones,” where care may be practised using a lingua franca, or in various configurations of language codes. This paper examines two foundational constructs, communicative competence and health literacy, that are implicated in the contact zones of health care. I propose a heuristic framework of spheres of activity for locating, articulating, and understanding the facets and workings of measured constructs as a basis for a multiperspectival, interdisciplinary research agenda. The framework is applied to a health literacy test to explore the multilayered texture of construct activity. Moving to the applicable world of the hospital ward, I consider what “health literacy” may look like in authentic doctor–patient interaction. Finally, I discuss the relationship between the different activities: what is operationalized in tests, what is wished for in policy, and what is evident in practice. Even though the capacity to communicate is considered a key ingredient in mobilizing health literacy for shared decision-making, communication is barely represented in operationalized constructs. An orientation to the interactional repertoires of health care and the dynamic nature of knowledge co-construction in health decision-making could generate useful development in theory, measurement, and practice.