Health literacy

Health literacy



The young and multidisciplinary field of health literacy emerged from two expert groups; physicians and other health providers and health educators, and Adult Basic Education (ABE) and English as Second Language (ESL) practitioners. Physicians are a source of groundbreaking patient comprehension and compliance studies. Adult Basic Education / English for Speakers of Languages Other Than English (ABE/ESOL) specialists study and design interventions to help people develop reading, writing, and conversation skills and increasingly infuse curricula with health information to promote better health literacy. A range of approaches to adult education brings health literacy skills to people in traditional classroom settings, as well as where they work and live.


Health literacy is an individual's ability to read, understand and use healthcare information to make decisions and follow instructions for treatment. Health literacy involves both the context (or setting) in which health literacy demands are made (e.g., health care, media, Internet or fitness facility) and the skills that people bring to that situation (Rudd, Moeykens, & Colton, 1999). ;CharacteristicsA study of 2,600 patients conducted in 1995 by two US hospitals found that between 26-60% of patients could not understand medication directions, a standard informed consent or basic health care materials. [cite journal | author = M. V. Williams, et al | year = 1995 | title = Inadequate functional health literacy among patients at two public hospitals | journal = JAMA | volume = 274 | issue = 21 | pages = 677–82 | url = | accessdate = 2006-06-30 | doi = 10.1001/jama.274.21.1677 ]

Biomedical Approach

The biomedical approach to health literacy that became dominant (in the U.S.) during the 1980s and 1990s often depicted individuals as lacking, or “suffering” from, low health literacy, assumed that recipients are passive in their possession and reception of health literacy, and believed that models of literacy and health literacy are politically neutral and universally applicable. This approach is found lacking when placed in the context of broader ecological, critical, and cultural approaches to health. This approach has produced, and continues to reproduce, numerous correlational studies (Pleasant & Kuruvilla, 2008).

A more robust view of health literacy includes the ability to understand scientific concepts, content, and health research; skills in spoken, written, and online communication; critical interpretation of mass media messages; navigating complex systems of health care and governance; and knowledge and use of community capital and resources, as well as using cultural and indigenous knowledge in health decision making (Nutbeam, 2000; Ratzan, 2001; Zarcadoolas, Pleasant, & Greer, 2002). This view sees health literacy as a social determinant of health that offers a powerful opportunity to reduce inequities in health.

This perspective defines health literacy as the wide range of skills, and competencies that people develop over their lifetimes to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks, and increase quality of life (Zarcadoolas, Pleasant, & Greer, 2006). While definitions vary in wording, they all fall within the conceptual framework offered in this definition.

Defining health literacy in that manner builds the foundation for a multi-dimensional model of health literacy built around four central domains (Zarcadoolas et al. 2005, 2006):
*fundamental literacy,
*scientific literacy,
*civic literacy, and
*cultural literacy.

Patient Safety and Outcomes

Health literacy deficits are likely to led to quality outcome and patient safety issues. For example, according to an Institute of Medicine (2004) report, low health literacy negatively affects the treatment outcome and safety of care delivery. [The Institute of Medicine: [ Health Literacy: A Prescription to End Confusion] (2004)] These patients have a higher risk of hospitalization and longer hospital stays, are less likely to comply with treatment, are more likely to make errors with medication, [cite journal | author = Terry C. Davis, PhD; Michael S. Wolf, PhD, MPH; Pat F. Bass III, MD; Jason A. Thompson, BA; Hugh H. Tilson, MD, DrPH; Marolee Neuberger, MS; and Ruth M. Parker, MD | year = 2006 | title = Literacy and Misunderstanding Prescription Drug Labels | journal = Annals of Internal Medicine | volume = 145 | issue = 12 | url = | accessdate = 2006-11-30 | pmid = 17135578 ] and are more ill when they seek medical care. [U.S. Department of Health and Human Services: [ Quick Guide to Health Literacy] ] cite journal | author = M. V. Williams, et al | year = 1995 | title = The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. | journal = J Gen Intern Med. | volume = 10 | issue = 10 | pages = 537–41 | url = | accessdate = 2006-06-30 ]

The mismatch between a clinician's level of communication and a patient's ability to understand can lead to medication errors and adverse medical outcomes. The lack of health literacy affects all segments of the population, although it is disproportionate in certain demographic groups, such as the elderly, ethnic minorities, recent immigrants and persons with low general literacy. [2003 National Assessment of Adult Literacy [ The Health Literacy of America’s Adults] Retrieved 9 September 2006]

Risk Identification

Identifying patients at risk due to low health literacy is productive. Health behaviors such as correct medication use, taking advantage of health screening and effective preventive measures such as exercise and smoking cessation improved when low literacy patients were given visual aids, easy readability brochures or videotapes. [Agency for Healthcare Research and Quality: Evidence Report/Technology Assessment: Number 87 [ Literacy and Health Outcomes] ] Several tests of health literacy have been developed to validate research studies, but a practical, three-minute assessment can be completed in a doctor's office. [cite journal | author = Barry D. Weiss, MD, et al | year = 2005 | title = Quick Assessment of Literacy in Primary Care: The Newest Vital Sign | journal = Annals of Family Medicine | volume = 3 | pages = 514–522 | url = | accessdate = 2006-06-30 | doi = 10.1370/afm.405 ] [ [ The Newest Vital Sign: a Health Literacy Assessment Tool] ]


Once identified, low health literacy patients benefit from providing limited but clear information at each visit, avoidance of medical jargon, using illustrations of important concepts and confirming information by a "teach back" method. A program called "Ask Me 3" [ [ Ask Me Three] ] is designed to bring public and physician attention to this issue, by letting patients know that they should ask three questions each time they talk to a doctor, nurse, or pharmacist:
*What is my main problem?
*What do I need to do?
*Why is it important for me to do this?

Finally, it must be stressed that health literacy skills are not only a problem 'in' the public. Health care professionals (doctors, nurses, public health professionals) can also have poor health literacy skills; most often captured by a reduced ability to clearly explain health issues to patients and the public.

ee also

* Adult Basic Education
* Health
* Health care
* Health promotion
* Health education
* Literacy
* Patient safety

References and Resources

External links

* [ A course on health literacy Rutgers, the State University of New Jersey taught by Andrew Pleasant]
* [ An introductory course on communication of environment and health in society and the mass media at Rutgers, the State University of New Jersey taught by Andrew Pleasant]
* [ Health literacy course and materials based at Harvard University led by Rima Rudd]
* [ Link to home page of Christina Zarcadoolas at Mt. Sinai University who teaches a course on health literacy]
* [ Special Collection on Health and Literacy]
* [ “A Selection of Health Literacy Articles and Research” published by Partnership for Clear Health Communication]
* [ Health Literacy Consulting. Includes the full-text of many health literacy articles as well as links to numerous resources.]
* [ Health Literacy Month]
* [ Health Action by People India (HAP)]
* [ Health Literacy Resource List for Educators, USDA NAL Food and Nutrition Information Center (PDF|76KB)]
* [ Link to Literacy Assistance Center health literacy resources for adult literacy educators and health care providers]
* [ Link to - InfoDyne Health Literacy Project (IHLP) is a non-profit organization that was founded in response to an overwhelming need for advocacy, research and the production of better health education tools to increase the level of health literacy across communities and improve patient safety and quality of care. Our mission is to save lives by increasing the level of health literacy across the spectrum of healthcare.]
* [ A collection of health literacy curricula]



*Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267.
*Pleasant, A. & Kuruvilla, S. (2008). A tale of two health literacies? Public health and clinical approaches to health literacy. Health Promotion International. Retrieved Feb. 28, 2008 from [] .
*Ratzan, S. C. (2001). Health literacy: Communication for the public good. Health Promotion International, 16(2), 207–214.
*Rootman, I., & Wharf-Higgins, J. (2007). [ Literacy and Health: Implications for Active Living] . WellSpring, 18 (4).
*Rudd, R., Moeykens, B. Colton, TC. (1999) Health and literacy: A review of medical and public health literature. In J. Comings, B. Garners, & C. Smith, eds. Annual Review of Adult Learning and Literacy, Volume I. New York, NY: Jossey-Bass.
*Zarcadoolas, C., Pleasant, A., & Greer, D. (2005). Understanding health literacy: An expanded model. Health Promotion International, 20, 195–203.
*Zarcadoolas, C., Pleasant, A., & Greer, D. (2006). Advancing health literacy: A framework for understanding and action. Jossey-Bass: San Francisco, CA.

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