Elsevier

Public Health

Volume 132, March 2016, Pages 3-12
Public Health

Review Paper
Health literacy: applying current concepts to improve health services and reduce health inequalities

https://doi.org/10.1016/j.puhe.2016.01.001Get rights and content

Abstract

The concept of ‘health literacy’ refers to the personal and relational factors that affect a person's ability to acquire, understand and use information about health and health services. For many years, efforts in the development of the concept of health literacy exceeded the development of measurement tools and interventions. Furthermore, the discourse about and development of health literacy in public health and in clinical settings were often substantially different. This paper provides an update about recently developed approaches to measurement that assess health literacy strengths and limitations of individuals and of groups across multiple aspects of health literacy. This advancement in measurement now allows diagnostic and problem-solving approaches to developing responses to identified strengths and limitations. In this paper, we consider how such an approach can be applied across the diverse range of settings in which health literacy has been applied. In particular, we consider some approaches to applying health literacy in the daily practice of health-service providers in many settings, and how new insights and tools – including approaches based on an understanding of diversity of health literacy needs in a target community – can contribute to improvements in practice. Finally, we present a model that attempts to integrate the concept of health literacy with concepts that are often considered to overlap with it. With careful consideration of the distinctions between prevailing concepts, health literacy can be used to complement many fields from individual patient care to community-level development, and from improving compliance to empowering individuals and communities.

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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