Health Literacy

  • teachers-book-and-apple-123rfHealth literacy is the ability to read, understand and effectively use basic medical instructions and information.


  • For health providers “health literacy includes the capacity of professionals and institutions to:
    • communicate effectively so that community members can make informed decisions and
    • take appropriate actions to protect and promote their health.”        


“Only now do I know how profoundly the gap between knowledge and practice is widened by limited health literacy.

Only now do I know why some refer to this as a “silent epidemic”—the lack of understanding by most professionals and policy makers of its extent and effect, and the individual shame associated with it that keeps it even more silent and hidden…”

Chair of the 2004 IOM Report on Health Literacy


Definitions:


Health literacy is defined in Healthy People 2010 as: “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”.


“Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.” (Definition from National Networks of Libraries of Medicine)

Key Points:

  • People with lower health literacy have poorer health outcomes (higher hospitalisation rates, higher health care costs and worse health status than people with adequate literacy) independent of socioeconomic and educational factors
  • Low health literacy can affect anyone of any age, ethnicity, background or education level.
  • Low health literacy can contribute to negative psychological effects and is often “hidden” to maintain dignity
  • If we are serious about improving the health of our patients and community, then understanding health literacy and identifying strategies to improve it, needs to be prioritised.
  • Over 50% of NZ adults are likely to experience health literacy difficulties (based on figures from the NZ Adult Literacy & Life Skills Survey 2006); therefore a focus on strategies to improve health literacy is essential


 

Why is health literacy important?

Reading labels is very difficult for many people

 

Health literacy is an essential life skill for individuals: It may help individuals seek and use information and take control over their health.

Health literacy is a public health imperative: building health literacy improves overall population health.

Health literacy is an essential part of social capital: low health literacy is a strong contributor to health inequalities.

Health literacy is a critical economic issue: and costs countries $billions every year.


Overview of Health Literacy

For an introduction and overview on health literacy, try the following websites and resources:

  • Easy to Read Patient Information – Medline Plus
  • National Network of Libraries of Medicine (USA) – comprehensive section covering range of topics ranging from background, research findings to skills needed and additional resources/listservs.
  • NZ Literacy Portal - The NZ Literacy Portal provides a useful source of information for anyone interested in adult literacy and related issues and this links to their health literacy section.
  • Health Literacy - Medline Plus – excellent section on health literacy with wide range of links and resources

 


Resources for Improving Health Literacy

Some excellent resources and programmes have been developed to help improve health literacy. (Note: most are from outside NZ)


3  Good Questions:

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this?

 

Tools for improving health literacy from US Department of Health & Health Services:


Strategies for improving health literacy

From Quick Guide to Health Literacy, US Dept Health & Health Services


TrainingHealth-Literacy-Patient-S

 

Assessment Tools for Health Literacy

A range of tools exist for assessing health literacy. Here are some links:

  • Assessing Reading A bility & Literacy Levels two-page Word document from the Ohio State University/AHEC Health Literacy Program describing seven strategies for assessing adult reading ability and literacy level. (Health Disparities Collaborative)


  • The Test of Functional Health Literacy in Adults, (TOFHLA) is a widely used health literacy assessment tool.
    • Advantages: good psychometric characteristicsand available in both English and Spanish,
    • Disadvantages: Time to administer limits it’s functionality in practice – full version (18 to22 minutes); short version (7 to 10 minutes)
    • Abstract


  • Newest Vital Sign Literacy Assessment Test – Rapid Estimate of Adult Literacy in Medicine – can be administered in less than 3 minutes, but only available in English. Abstract

 

References & additional links

  • Healthy People 2010 (very large file! Over 12 MB)
  • Johnson, K. Weiss, BD. How Long Does It Take to Assess Literacy Skills in Clinical Practice? J Am Board Fam Med 2008;21 211-214 [Abstract] [full text pdf]
  • Johnson A, Sandford J, Tyndall J. Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Database of Systematic Reviews 2003, Issue 4. Abstract
  • Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. 2003. Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 163(1): 83-90
  • Safeer RS, Keenan J. Health literacy: the gap between physicians and patients. Am Fam Physician. 2005 Aug 1;72(3):463-8. [Abstract] [Full article pdf]

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