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Background: Multidimensional health literacy refers to the personal knowledge and competencies an individual accumulates, mediated by organisational structures and resource availability, which enable an individual to access, understand, appraise and use health information and services to promote and maintain good health. Research on general populations has found that low health literacy is associated with a range of poorer health outcomes. Minimal research has examined health literacy of people accessing specialist mental health or substance use disorder (SUD) treatment services, despite this population experiencing health inequalities, and requiring good access to healthcare. This thesis comprises four studies which overall aim to explore and understand the multidimensional health literacy levels of people accessing specialist mental health or SUD treatment services. Methods: Study 1 was a systematic review and comprised 14 empirical studies that examined health literacy of people liv

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