Compensatory Network Capital: Negative and Ambivalent Ties in the Conversion of Health Literacy into Action

Critical health literacy has strengthened attention to inequality, power and structural conditions, but less is known about the relational processes through which health-related competencies are translated into action in everyday healthcare. This qualitative study examined how negative and ambivalent social ties shaped the conversion of health-related knowledge, intentions and professional advice into observable health action among adults living with multimorbidity in contexts of social vulnerability. Twelve semi-structured interviews were conducted with adults recruited through municipal health promotion and rehabilitation services, and follow-up contact with survey respondents. Analysis was abductive and used Compensatory Network Capital (CNC) as a sensitising framework. Through interviews, participants often demonstrated knowledge, motivation and awareness of recommended care. However, action was frequently delayed, redirected, or blocked when support was difficult to mobilise, poorly matched to the task, insufficiently recognised in institutional encounters, or unavailable to act on another’s behalf. These patterns were captured through four tie-level mechanisms: Activation, functional specificity, recognition and substitution. Negative and ambivalent ties operated not only as psychosocial stressors but also as practical barriers affecting help-seeking, follow-up, care coordination and digital navigation. The study contributes to critical health literacy by specifying a micro–meso relational layer through which structural and institutional conditions are enacted in practice. It suggests that equity-oriented health promotion should address not only individual skills, but also the relational and organisational conditions that enable health-related action.