Review PaperHealth literacy: applying current concepts to improve health services and reduce health inequalities
Section snippets
What is health literacy and why is it important?
Since its emergence in the 1970s,1 the concept of health literacy has become increasingly broad. It began as a notion that concentrated only on people's ability to read and understand written information. The concept now includes numerous factors that affect a person's ability to access, understand and use health information from many sources. Although health literacy is in many health policies around the world, it remains challenging to embed health literacy principles into routine practice.
Health literacy: multiple components and multiple settings
Health literacy is a multidimensional concept and this has led to the emergence of several definitions. The World Health Organization defines health literacy as ‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health’ and states that ‘health literacy implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal
Measurement of health literacy
Measuring the many components of health literacy, as they exist in various settings and contexts, is an important step in addressing issues of health inequity. A weakness in the health literacy field is that the most commonly used tools mainly test reading, comprehension and numeracy skills, and some cognitive tasks, rather than the broad range of issues included in modern definitions of health literacy.2, 3, 9, 10, 11, 12, 13, 14
The development of new measurement tools, which identify specific
Health literacy strategies in health service settings
One of the assumptions underlying the measurement of health literacy is that different strategies of engagement, education and service delivery are appropriate for people with different health literacy needs. This is not to say that every patient of a health service must have their health literacy measured, but that health service personnel must to be aware of, and sensitive to, the range of health literacy needs that patients present with. In this section we propose three main strategies for
Health literacy and access to health services: we need to consider those who don't make it to the clinic door
One of the problems with many approaches to health literacy interventions in healthcare settings is that they focus only on those patients who are already accessing health services. However, the overall effectiveness of a health service organisation is largely dependent on whether or not the people who need it most actually access the service. Low health literacy – as represented by such issues as low educational attainment and low socio-economic position – is a major barrier to access for many
Health literacy strategies in community and population settings
Many people live in situations where health-related decisions are not made just by individuals but are strongly influenced by family members, peers or community leaders. Communal decision-making processes are common in much of Asia and Africa, and are apparent in immigrant and refugee groups.39, 40, 41, 42
The concept of distributed health literacy was proposed by Edwards et al.43 and refers to the way in which health literacy is distributed throughout a group of individuals or a community. An
Toward an inclusive model of health literacy
Over the past few decades, health literacy work has occurred in diverse settings: from settings where people are overwhelmed by an abundance of choice of health information, health services, and treatments, to settings where people have limited education and few healthcare options. The scope of health literacy assessment varies from individual care planning in clinical settings to making international comparisons. Research about health literacy also depends on issues such as ideology and
Conclusion
Needs-based health literacy assessment can identify and help healthcare providers develop strategies that build the capacities of individuals and communities to make decisions that promote health. This is not solely a concern and responsibility for front-line health practitioners. It must be a concern and responsibility at all levels of health systems.
Practitioners, health service managers, policy makers, academics and consumer groups need to understand and measure health literacy so as to
Acknowledgements
This is an invited review which has been subject to peer review.
Ethical approval
None sought.
Funding
Richard Osborne is funded in part through a National Health and Medical Research Council (NHMRC) Senior Research Fellowship #APP1059122. Rachelle Buchbinder is funded by an NHMRC Senior Principal Research Fellowship #APP1082138.
Competing interest
The authors have no competing interests.
Author contributions
Richard Osborne and Roy Batterham conceived the paper, and with Rachelle Buchbinder, developed the first draft. Melanie Hawkins and Alf Collins then
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