Health Literacy

Original Editor - Oyemi Sillo

Top Contributors - Naomi O'Reilly, Ines Musabyemariya, Kim Jackson, Ewa Jaraczewska, Jess Bell, Carina Therese Magtibay, Vidya Acharya and Carin Hunter  

Introduction[edit | edit source]

Health literacy is the ability to get, process, understand and apply health information and services in order to make appropriate health decisions. It involves applying various skills to health situations, including reading, listening, numeracy, analytical, and decision-making skills. Health literacy relies on general literacy skills and has been described as “the bridge between literacy (and other) skills and abilities of the individual and the health context.”[1]

However, even people with average general literacy skills might find health information too complex or technical. Inadequate health literacy hinders adherence to prescription and treatment instructions.[2] Also, people with low health literacy tend to be less healthy and are less likely to utilise disease prevention services and information.[1] They also have higher hospitalisation rates and worse health outcomes.[3] Poor health literacy leads to increased health care costs, thus posing an economic burden to societies. Low health literacy has been found to be a major financial drain on the US healthcare system, costing the economy between $106 billion and $238 billion annually. [4]

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Levels of Health Literacy[edit | edit source]

There are three levels of health literacy: functional, interactive, and critical.

Functional health literacy[edit | edit source]

Functional health literacy consists of a person's basic skills to function well in health contexts; reading, writing and numeracy skills. [6] [7] [8] [9]

Examples:

  • Being able to read the signpost in a hospital
  • Being able to read the instruction on the medical tab

Interactive Health literacy[edit | edit source]

Cognitive literacy skills, where a person uses health information to change attitudes, perceptions, and health behaviours to promote individual self-help. [7] [6][10]

Examples: [11]

  • Ability to interpret and apply health information to changing circumstances
  • Applied the collected information to your daily life.

Critical Health Literacy[edit | edit source]

This level consists of the ability of a person to critically analyse health information and use them to exercise control over a health situation or health condition. [6] [7] [10]

Examples: [11]

  • Why the author presented this health information with red colour?
  • Why did he/she use this image?
  • Making health-related decisions based on collected health information
  • Checking the information collected if they are valid.

Subdimensions[edit | edit source]

The 2012 European Health Literacy Survey identified 12 subdimensions of health literacy that refer to the competencies required for obtaining, understanding, processing, and using in health care, disease prevention and health promotion settings. These have been used as a conceptual basis to assess health literacy and to develop interventions to address health literacy limitations. Health literacy is the ability of an individual to obtain, process, and understand necessary health information. Low reading skills and poor English language comprehension make it challenging for the refugee to navigate in the new environment. A study by Baker[12] shows that the health literacy barrier affects refugees with limited English proficiency more than native English speakers.[12]

Refugees with low health literacy are less likely to understand written or verbal information from their healthcare providers, follow medications or appointment schedules, or navigate the healthcare system to obtain medical care. Thus, leading to non-adherence to treatment. Low health literacy can have serious health consequences and put additional demands on the health care system. It has been found that a lack of health literacy results in difficulty in filling and refilling prescription medications, reading medicine labels, understanding the right dose, and taking medications at the right time.[13]

Principles for Writing and Designing of Health Information[edit | edit source]

As the delivery of health care services becomes more patient-centred, clear communication between patients and health care providers is of the utmost importance. Patients need strong health literacy skills to utilise health information and services adequately. Health workers also need health literacy skills to effectively communicate health information to patients.[14] Even health systems need to be health literate in order to provide easy access to health care services and information and to empower patients to utilise the range of available services adequately.[15] The following principles have been offered to guide the writing and designing of health information to ensure that they are aligned with the skills and abilities of the users.[16]

Planning[edit | edit source]

Start planning by defining the communication objective and the target audience. Determine the audience's needs, interests, and behaviours, as well as how you can best engage them. Also, plan to involve the target audience during the development and testing phases of your production.[16]

Content[edit | edit source]

Clearly state your objectives in the title, cover illustration and introduction; avoid vague or numerous objectives. Ensure that your content is accurate and relevant and that the main action points are summarised or repeated. Use effective translations or interpretations where necessary, and ensure that your content is relevant to the culture and demographics of the target audience. Keep the content clear, simple, and positive, and include information such as references, publication dates, and websites or phone numbers for further information.[16]

Literacy Demands[edit | edit source]

Ensure your writing is easy for your target audience to read and understand. Use common, everyday words. Avoid using unnecessary abbreviations, acronyms, jargon, technical terms, and abstract words. Use short sentences and paragraphs, and write with an active voice. Use numbers simply and directly; avoid complicated statistics or calculations. Use whole numbers, and choose frequencies over percentages.[16]

Organisation[edit | edit source]

Organise your information in a logical way that is easy to follow. Emphasise important information by placing them at the beginning and the end. Group information in small sections logically, and give the sections simple and explanatory headings.

Layout and Typography[edit | edit source]

Choose clear font types (e.g. Times New Roman or Arial) in easily readable sizes (preferably 12-16 points). Limit the variation of fonts, and use a mix of upper and lowercase letters. Also, utilise white space by separating paragraphs with a line or two and breaking up blocks of text with graphics. Use bulleted lists, underlining and bold to emphasise key messages. Use colour to highlight, add clarity, or differentiate sections. And direct attention to specific content with shading, boxes, or arrows.[16]

Graphics[edit | edit source]

Use engaging and inclusive pictures that are attractive, easy to recognize, and highlight your objectives. Choose action-oriented graphics that reinforce the key messages and reflect the target audience's culture and demographics. Also, ensure that the graphics are simple and not too busy.[16]

Role of Physiotherapy[edit | edit source]

Patient education is an important aspect of physiotherapy practice, particularly in the context of self-management of chronic diseases. Chronic diseases are associated with several modifiable risk factors; understanding these risk factors and affecting the necessary lifestyle changes is essential to preventing and managing chronic diseases. Patients with limited health literacy tend to have a higher prevalence of health risk factors, lower participation in disease prevention activities, and poorer self-management skills. The 2012 European Health Literacy Survey found a strong association between higher health literacy and frequent physical activity.[17] Effective communication is essential for patients to make better, informed healthcare decisions. Thus, physiotherapists should ensure that they provide information to patients in ways that enable them to understand and use it. Physiotherapists can help minimise the problems of low health literacy by identifying and supporting patients with low literacy through:

  • Using of screening tests to aid health providers in identifying patients with low health literacy [18]
  • Creating more readable health information [18]
  • Providing health information cards/pamphlets to increase health literacy [12]
  • Using communication tools in the form of pictures, audiotapes, and interactive computer programs to convey health information [18]
  • To compensate for poor reading skills, individuals depend on their listening skills, so the health care provider should speak clearly and slowly, avoiding medical jargon. It is essential to verify the individuals' understanding and comprehension by asking them to repeat what they have understood regarding the diagnosis and treatment [18]
  • Educating children and adults about health issues [18]
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Barriers and Facilitators of Health Literacy[edit | edit source]

  • Cultural barriers [19][20]
  • Language barriers [19][20]
  • Health Professional Education on Health literacy public health issues[21]
  • Health Care System which is not attentive to health literacy, has a poor organizational commitment and does not have policies and procedures supporting Health literacy. This prevents patients from being engaged in prevention activities[22]
  • Financial barriers: There is a need to invest in interventions that improve inclusive health communication to help users to actively engage in decision-making about their health. This includes the development of Health literacy tools, training healthcare professionals, allocating funds to Health literacy activities, etc.: [20]
[23]

Resources[edit | edit source]

  1. Boston University Health Literacy Tool Shed
    • "The Health Literacy Tool Shed is an online database of health literacy measures. The site contains information about measures, including their psychometric properties, based on a review of the peer-reviewed literature. You can learn about the range of health literacy measurement tools available and find tools that meet your needs."
  2. Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit
    • "The AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition, can help primary care practices reduce the complexity of healthcare, increase patient understanding of health information, and enhance support for patients of all health literacy levels. Health literacy universal precautions are the steps practices take when they assume that all patients may have difficulty comprehending health information and accessing health services."
  3. Health Literacy for Public Health Professionals
    • Free online course on Health Literacy for Public Health Professionals focusing on Communication Skills.
  4. Effective Communication for Healthcare Teams
    • Free online course on Effective Communication for Healthcare Teams; Addressing Health Literacy, Limited English Proficiency and Cultural Differences.
  5. Victorian Refugee Health Network
    • Have developed a range of resources for healthcare professionals around health literacy for the refugee population. Focus on Australia.
  6. Enliven Organisational Health Literacy Self-assessment Resource
    • "The Enliven Organisational Health Literacy Self-assessment Resource aims to provide health and social service organisations with a self-assessment tool that can be used to guide and inform their development as health literate organisations."

References[edit | edit source]

  1. ↑ 1.0 1.1 Institute of Medicine (US) Committee on Health Literacy; Nielsen-Bohlman L, Panzer AM, Kindig DA, editors. Health Literacy: A Prescription to End Confusion. Washington (DC): National Academies Press (US); 2004.
  2. ↑ Bennett IM, Chen J, Soroui JS, et al. The contribution of health literacy to disparities in self-rated health status and preventive health behaviours in older adults. (link is external) Annals of Family Medicine, 2009, May-Jun;7(3):204-11
  3. ↑ Schillinger D, Grumbach K, Piette J, et al. Association of Health Literacy With Diabetes Outcomes. Journal of the American Medical Association. 2002;288(4):475-482. doi:10.1001/jama.288.4.475.
  4. ↑ Vernon, J. A., Trujillo, A, Rosenbaum, S, (2007). Low health literacy: Implications for national health policy.
  5. ↑ NASEM Health and Medicine Division. Health Literacy: A Prescription to End Confusion - Patients. Available from: https://youtu.be/iCvQyRhpI4Q[last accessed 30/08/20]
  6. ↑ 6.0 6.1 6.2 Rademakers J, Heijmans M. Beyond Reading and Understanding: Health Literacy as the Capacity to Act. International Journal of Environmental Research and Public Health. 2018; 15(8):1676. https://doi.org/10.3390/ijerph15081676
  7. ↑ 7.0 7.1 7.2 Don Nutbeam, Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century, Health Promotion International, September 2000; 15(3):259–267, https://doi.org/10.1093/heapro/15.3.259
  8. ↑ Beukema, L., Reijneveld, S.A., Jager, M. et al. The role of functional health literacy in long-term treatment outcomes in psychosocial care for adolescents. Eur Child Adolesc Psychiatry 2020; 29:1547–1554. https://doi.org/10.1007/s00787-019-01464-9
  9. ↑ Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med 2004;36:588–594
  10. ↑ 10.0 10.1 Heide, I. van der, Heijmans, M., Schuit, A.J., Uiters, E., Rademakers, J. Functional, interactive and critical health literacy: varying relationships with control over the care and number of GP visits. Patient Education and Counseling 2015; 98(8), 998-1004
  11. ↑ 11.0 11.1 Hirono Ishikawa, Takeaki Takeuchi, Eiji Yano; Measuring Functional, Communicative, and Critical Health Literacy Among Diabetic Patients. Diabetes Care 1 May 2008; 31 (5): 874–879. https://doi.org/10.2337/dc07-1932
  12. ↑ 12.0 12.1 12.2 Baker DW. The meaning and the measure of health literacy. Journal of general internal medicine. 2006 Aug 1;21(8):878-83.https://pubmed.ncbi.nlm.nih.gov/16881951/
  13. ↑ 13.0 13.1 VCH Primary Care. Health Literacy Basics for Health Professionals. Available from: http://www.youtube.com/watch?v=_8w9kdcRgsI[last accessed 30/08/20]
  14. ↑ Coleman C., Kurtz-Rossi S., McKinney J., Pleasant A., Rootman I., Shohet L. The Calgary Charter on Health Literacy: Rationale and Core Principles for Developing Health Literacy Curricula. 2010
  15. ↑ Cindy Brach, Debra Keller, Lyla M. Hernandez, Cynthia Baur, Ruth Parker, Benard Dreyer, Paul Schyve, Andrew J. Lemerise, and Dean Schillinger. Ten Attributes of Health Literate Health Care Organizations. June 2012. IOM Roundtable on Health Literacy
  16. ↑ 16.0 16.1 16.2 16.3 16.4 16.5 Jacobson, Kara L; Parker, Ruth M. Health Literacy Principles: Guidance for Making Information Understandable, Useful, and Navigable. IOM Roundtable on Health Literacy. December 22, 2014.
  17. ↑ Health Literacy: The Solid Facts. World Health Organisation Regional Office for Europe. 2013
  18. ↑ 18.0 18.1 18.2 18.3 18.4 Schloman B. Information Resources Column:" Health Literacy: A Key Ingredient for Managing Personal Health.". Online Journal of Issues in Nursing. Available: www. nursing world. org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No2May04/HealthLiteracyAKeyIngredientforManagingPersonalHealth. aspx. 2004.
  19. ↑ 19.0 19.1 Singleton, K., Krause, E., "Understanding Cultural and Linguistic Barriers to Health Literacy "The Online Journal of Issues in Nursing. 2009;14(3):Manuscript 4. DOI: 10.3912/OJIN.Vol14No03Man04
  20. ↑ 20.0 20.1 20.2 Baraka Muvuka, PhD, MPH, Ryan M. Combs, PhD, MA , Suur D. Ayangeakaa, PhD, MPH, Nida M. Ali, PhD, PH, Monica L. Wendel, DrPH, MA, and Trinidad Jackson, MS, MPH: Health Literacy Research and Practice, 2020;4(3):e138–e143 https://doi.org/10.3928/24748307-20200617-01
  21. ↑ Lauren K. Tormey, MD and others, Understanding Health Literacy and its Impact on Delivering Care to Patients with Inflammatory Bowel Disease, Inflammatory Bowel Diseases, 1 March 2016;22(3): 745–751, https://doi.org/10.1097/MIB.0000000000000622
  22. ↑ Charoghchian Khorasani E, Tavakoly Sany SB, Tehrani H, Doosti H, Peyman N. Review of Organizational Health Literacy Practice at Health Care Centers: Outcomes, Barriers and Facilitators. International Journal of Environmental Research and Public Health. 2020; 17(20):7544. https://doi.org/10.3390/ijerph17207544
  23. ↑ Centers for Disease Control and Prevention (CDC). Dr. Rima Rudd. Available from: http://www.youtube.com/watch?v=4N8QxVkjHRY[last accessed 30/08/20]
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