https://doi.org/10.1177/1757975918793334 Global Health Promotion 1757-9759; Vol 25(4): 34–47; 793334 Copyright © The Author(s) 2018, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975918793334 journals.sagepub.com/home/ghp Introduction It is recognised that health information that allows people to make healthy lifestyle choices is fundamental to their ability to achieve their health potential. However, this requires people and communities to access, appraise, understand and apply information (health literacy) to make timely and appropriate health decisions relevant to their self-management (1,2). This is known as health literacy. There are several definitions of health literacy (HL). Recently, public health has focused on definitions such as Dodson et al.’s (3:1): Health literacy refers to the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health or that have implications for health. Health literacy includes the capacity to communicate, assert and enact these decisions Such definitions embrace a social approach to HL and shift the focus from HL as set of skills that reside in individuals to a more socio-cultural view of literacy. A socio-cultural view of HL enables sharing of knowledge and skills and debate around health issues. It can also result in the co-creation of knowledge and in communities taking ownership of their health decisions (3–6). Researchers who advocate for a socio- cultural framework of literacy (7–9) argue for a higher- level broader approach to literacy than previous 793334PED 0 0 10.1177/1757975918793334E. McElhinney et al. research-article 2018 1. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK. 2. College of Medicine, University of Glasgow, Glasgow, UK. 3. School of Health Sciences, University of East Anglia, Norwich, UK. Correspondence to: Evelyn McElhinney, School of Health and Life Sciences, Department of Nursing and Community Health, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK. Email: Evelyn.McElhnney@gcu. ac.uk, telephone : 0141 331 8791 (This manuscript was submitted on 13 October 2017. Following blind peer review, it was accepted for publication on 3 June 2018) Health literacy practices in social virtual worlds and the influence on health behaviour Evelyn McElhinney 1 , Lisa Kidd 2 and Francine M. Cheater 3 Abstract: This study explored how health information accessed via a 3D social virtual world and the representation of ‘self’ through the use of an avatar impact physical world health behaviour. In-depth interviews were conducted in a sample of 25 people, across 10 countries, who accessed health information in a virtual world (VW): 12 females and 13 males. Interviews were audio-recorded via private in-world voice chat or via private instant message. Thematic analysis was used to analyse the data. The social skills and practices evidenced demonstrate how the collective knowledge and skills of communities in VWs can influence improvements in individual and community health literacy through a distributed model. The findings offer support for moving away from the idea of health literacy as a set of skills which reside within an individual to a sociocultural model of health literacy. Social VWs can offer a place where people can access health information in multiple formats through the use of an avatar, which can influence changes in behaviour in the physical world and the VW. This can lead to an improvement in social skills and health literacy practices and represents a social model of health literacy. (Global Health Promotion, 2018; 25(4): 34–47) Keywords: health literacy, qualitative research, 3D social virtual worlds, Second Life, health research, health behaviour Original Article