The way health systems and services are designed and delivered places high health literacy demands on people, families and whānau.
What is health literacy for people, families and whānau?
Health literacy is about knowing how to:
- find your way around the many different parts of the health system
- understand your health condition(s), including what makes it better or worse
- use your medicines safely
- give informed consent to medical procedures
- prevent illness and your health getting worse
- manage long-term health conditions well.
The health literacy you need changes over time as your health changes and health services change.
Historically, the language used to describe the difference between the health knowledge people had and the knowledge they needed implied the problem was with the consumer. People were described as having ‘low health literacy’. This consumer-deficit view of health literacy is unfair as it ignores the role of the health system in creating health literacy demands and how these impact on people’s health literacy.
We now recognise that high literacy demands are created by the way health conditions are explained, managed and resourced by the health system, health services and providers.
The provision of adequate health care includes providing people with the information they need, in a way that works for them, so they can make informed decisions and manage their health. This role is described as meeting health literacy needs. This is reflected in the Ministry of Health’s Framework for health literacy published in 2015.
A framework for health literacy in Aotearoa New Zealand
The framework for health literacy aims to address some of the systemic issues creating barriers to health literacy.
“Because of the way health systems are organised, individuals and whānau can often face a series of demands on their health literacy ... A health-literate health system reduces these demands on people and builds the health literacy skills of its workforce, and the individuals and whānau who use its services. It provides high quality services that are easy to access and navigate and gives clear and relevant health messages so that everyone living in New Zealand can effectively manage their own health, keep well and live well.”
The Ministry of Health developed the framework because it is committed to a health system that enables everyone living in Aotearoa New Zealand to live well and keep well. Building health literacy is an important part of this, and the framework outlines expectations for the health system, health organisations and all the health workforce to take action that:
- supports a culture shift so that health literacy is core business at all levels of the health system
- reduces health literacy demands
- recognises that good health literacy practice contributes to improved health outcomes and reduced health costs.
The framework also identifies some success indicators that individuals and whānau can expect to see from every point of contact with the health system.
Why does understanding health literacy demands matter?
The complexity and accessibility of health information (spoken and written), care and services affects all aspects of health: prevention, acute care, long-term conditions and public health. This complexity leads to more negative health outcomes than if spoken and written information was provided in a way that was clear and easy to access and understand.
This complexity is also an equity issue because Māori and Pasifika are more likely to not have their health information needs met. This is also the case for consumer groups whose first language is not English, have a disability, use NZ Sign Language or are blind or visually impaired. In addition, care and services need to be culturally safe to meet the needs of everyone.
What can healthcare providers do to improve health literacy?
Healthcare providers have a responsibility to provide spoken and written information, care and services in ways that meet the needs of health consumers. Providers also need to help people understand what they need to know to live healthy lives.
In terms of spoken and written information, they need to:
- use plain language where possible (written and spoken)
- explain clinical language and sector terms
- identify what people know or don’t know before providing information, so new information connects to prior knowledge
- talk people through referrals to unfamiliar health services to ensure they know what to expect
- thoroughly check that people have been given the important information they need, in a way that makes sense to them, before leaving a health service
- provide information in different formats, such as videos, apps and tools and support people to use these formats
- use photos, illustrations, diagrams and other non-written aids to support written content
- translate information into multiple languages
- make NZ Sign Language videos.
Use techniques such as Ask, Build, Check to improve how we communicate as health providers
View these three videos for examples and then start practicing this approach.
- Using Ask, Build, Check with a person with high blood pressure
- Using Ask, Build, Check: with a person with high cholesterol
- Using Ask, Build, Check: with a person as part of their diabetes annual review
The health literacy focus needs to extend beyond personal communication. Health literacy involves changing the healthcare environment and how knowledge is shared.
What happens if the health system places high literacy demands on people?
High health literacy demands and failing to meet health literacy needs contributes to premature morbidity and mortality, poorer access to health care, inequity, treatment/medicine safety concerns, informed consent and quality of care issues.
About health literacy Health Literacy NZ
Health Literacy NZ
Ask, Build, Check training module Self-Management Support Toolkit website
Health literacy review – a guide Ministry of Health, NZ, 2015
A framework for health literacy Ministry of Health, NZ, 2015
Equity of health care for Maori – a framework Ministry of Health, NZ, 2014
Kōrero mārama – health literacy and Māori Ministry of Health, NZ, 2010
For more information about care planning, visit our dedicated Self-Management Support (SMS) Toolkit website for health providers and healthcare staff.
- Rudd RE. Health literacy considerations for a new cancer prevention initiative The Gerontologist, 2019 Jun; 59(1):S7–S16.
- Brega AG, Hamer MK, Albright K. Organizational health literacy: Quality improvement measures with expert consensus Health Lit Res Pract. 2019 Apr; 3(2): e127–e146.