Health literacy is about improving understanding of health information so that health messages can be understood and, hopefully, acted upon.
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.
What is health literacy?
Health literacy is defined as:
"The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make informed and appropriate health decisions."
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.
Health literacy is not just the ability to read. Health literacy requires:
- analytical and decision-making skills
- the ability to apply these skills to health situations.
Why is health literacy important?
Poor health literacy is very common. More than 50% of the adult New Zealand population is likely to have some difficulties with health literacy.
Results from Korero marama – health literacy and Māori confirm that:
- on average, New Zealanders have poor health literacy skills
- up to 80% of Māori men and 75% of Māori women have poor health literacy skills and are at risk of adverse outcomes.
Low health literacy may translate to practical difficulties such as:
- trouble understanding appointment letters
- difficulty filling in forms
- finding it challenging to understand educational resources
- misinterpretation of medication instructions.
What are the possible health impacts of low health literacy?
- Premature morbidity and mortality – low health literacy has been shown to be an independent risk factor for poorer health, increased complications and hospitalisations and dying younger than one’s peers (American Medical Association).
- Poorer access to healthcare – difficulties with health literacy can result in difficulty accessing healthcare, following instructions from a clinician and medication errors (Safeer, 2005).
- Safety – a study showed that only 35% of people with basic or below basic health literacy could correctly demonstrate how they would take their medications when asked, “Show me how many pills you would take in one day”. The instructions on the bottle said, “Take two tablets by mouth twice daily” (Davis 2006).
- Increased costs – low health literacy costs countries billions of dollars per year. In the US, this is estimated to be between $106 billion to $238 billion each year. This represents between 7–17% of all personal healthcare expenditure (George Washington University Medical Center School of Public Health and Health Services).
- Hidden problem – shame and embarrassment are very common responses for people with limited health literacy:
- People regularly report going to extraordinary efforts to hide and cover up any reading or comprehension difficulties.
- While reading ability is related, there are many other factors that contribute to health literacy so you can't assume literacy based on education or occupation.
- Patient experience – low health literacy contributes to higher rates of misunderstanding, mismatched care to patient preferences, poor patient experience and complaints.
- Consent, inequality issues and quality of care – the high health literacy demands of our health system has major implications for informed consent, health inequalities and reduced quality of care.
A framework for health literacy in New Zealand
In 2015, the Ministry of Health published a framework for addressing some of the system issues creating barriers to health literacy.
A framework for health literacy – a health system response
"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." (Ministry of Health, NZ, 2015)
The Ministry of Health developed this framework because it is committed to a health system that enables everyone living in 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.
Using the framework
To get this framework working in the health system, it is necessary to build leadership and knowledge of health literacy approaches. In this way, the health system can make the long-term and sustainable changes needed to become health literate.
The framework also identifies some success indicators that individuals and whānau can expect to see from every point of contact with the health system.
Health literacy demands – what are they?
Health literacy demands are tasks individuals and whānau need to do to get well and keep well, and those created at points of contact with health services. For example, tasks may include the following:
- Arranging appointments – understanding a letter and its instructions, making a phone call to confirm, arranging time off work and transport to attend.
- Attending appointments – navigating an unfamiliar environment to find a service, interacting with reception staff, answering questions, providing a history and personal details, and understanding health practitioners’ instructions about tests, medications and follow-up appointments.
Health literacy review – a guide Ministry of Health, NZ, 2015
About health literacy Health Literacy NZ
Korero marama – health literacy and Māori Ministry of Health, NZ, 2010
Literacy and child health – a systematic review American Medical Association, US, 2009
Health literacy interventions and outcomes – an updated systematic review Department of Health and Human Sciences, US, 2011
Health literacy – a prescription to end confusion Institute of Medicine, US, 2004
Healthy people Department of Health and Human Services, US
Health literacy NZ Workbase NZ
Comprehensive section covering various topics from background, research findings to skills needed and additional resources National Network of Libraries of Medicine, US
Health literacy – wide range of health literacy links and resources Medline Plus, US