Health literacy
Health literacy is the ability to obtain, read, understand, and use healthcare information in order to make appropriate health decisions and follow instructions for treatment.[1] There are multiple definitions of health literacy,[2] in part, because 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.[3]
Since health literacy is a primary contributing factor to health disparities, it is a continued and increasing concern for health professionals.[4] The 2003 National Assessment of Adult Literacy (NAAL) conducted by the US Department of Education found that 36% of participants scored as either "basic" or "below basic" in terms of their health literacy and concluded that approximately 80 million Americans have limited health literacy.[5] These individuals have difficulty with common health tasks including reading the label of a prescribed drug.[6] Several factors may influence health literacy. However, the following factors have been shown to strongly increase this risk: age (especially patients 65 years and older), limited English language proficiency or English as a second language, chronic conditions, less education, and lower socioeconomic status.[7] Patients with low health literacy understand less about their medical conditions and treatments and overall report worse health status.[8]
Various interventions, such as simplifying information and illustrations, avoiding jargon, using "teach-back" methods, and encouraging patients' questions, have improved health behaviors in persons with low health literacy.[9] The proportion of adults aged 18 and over in the U.S., in the year 2010, who reported that their health care providers always explained things so they could understand them was about 60.6%.[10] This number increased 1% from 2007 to 2010.[10] The Healthy People 2020 initiative of the United States Department of Health and Human Services (HHS) has included health literacy as a pressing new topic, with objectives for improving it in the decade to come.[11]
In planning for Healthy People 2030 (the fifth edition of Healthy People), HHS[12] issued a "Solicitation for Written Comments on an Updated Health Literacy Definition for Healthy People". Several proposals address the fact that "health literacy is multidimensional",[13] being the result of a concerted effort that involves the individual seeking care or information, providers and caregivers, the complexity and demands of the system, and the use of plain language for communication.
Definition[edit]
Health literacy encompasses a 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.[14]
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; knowledge and use of community capital and resources; and using cultural and indigenous knowledge in health decision making.[15][16][17] This integrative view sees health literacy as a social determinant of health that offers a powerful opportunity to reduce inequities in health.
Health literacy is important in a community because it addresses health inequalities. It is no coincidence that individuals with lower levels of health literacy live, disproportionately, in communities with lower socio-economic standing. A barrier to achieving adequate health literacy for these individuals is a lack of awareness, or understanding of, information and resources relevant to improving their health. This knowledge gap arises from both patients being unable to understand information presented to them and hospitals' inadequate efforts and materials to address these literacy gaps.[18]
The levels of health literacy are considered adequate when the population has sufficient knowledge, skills, and confidence to guide their own health, and people are able to stay healthy, recover from illness, and/or live with disability or disease.[18]
eHealth literacy describes an individual's ability to search for, access, comprehend, and appraise desired health information from electronic sources and to then use such information to attempt to address a particular health problem.[58] It has become an important topic of research due to the increasing use of the internet for health information seeking and health information distribution. Stellefson (2011) states, "8 out of 10 Internet users report that they have at least once looked online for health information, making it the third most popular Web activity next to checking email and using search engines in terms of activities that almost everybody has done."[59] Though in recent years, individuals may have gained access to a multitude of health information via the Internet, access alone does not ensure that proper search skills and techniques are being used to find the most relevant online and electronic resources. As the line between a reputable medical source and an amateur opinion can often be blurred, the ability to differentiate between the two is important.[60]
Health literacy requires a combination of several different literacy skills in order to facilitate eHealth promotion and care. Six core skills are delineated by an eHealth literacy model referred to as the Lily model. The Lily Model's six literacies are organized into two central types: analytic and context-specific. Analytic type literacies are those skills that can be applied to a broad range of sources, regardless of topic or content (i.e., skills that can also be applied to shopping or researching a term paper in addition to health) whereas context-specific skills are those that are contextualized within a specific problem domain (can solely be applied to health). The six literacies are listed below, the first three of the analytic type and the latter three of the context-specific:
According to Norman (2006), both analytical and context-specific literacy skills are "required to fully engage with electronic health resources." As the World Wide Web and technological innovations are more and more becoming a part of the healthcare environment, it is important for information technology to be properly utilized to promote health and deliver health care effectively.The utilization of digital health information resources and the integration of digital interactions with healthcare providers offer significant advantages, with the potential to enhance healthcare system efficiency, quality, and accessibility, all while empowering patients.[61]
It has also been suggested that the move towards patient-centered care and the greater use of technology for self-care and self-management requires higher health literacy on the part of the patient.[62] This has been noted in several research studies, for example among adolescent patients with obesity.[63]
Improvement[edit]
Incorporate information through the university level[edit]
The United States Department of Health and Human Services created a National Action Plan to Improve Health Literacy.[64] One of the goals of the National Action Plan is to incorporate health and science information in childcare and education through the university level. The target is to educate people at an early stage; that way individuals are raised with health literacy and will have a better quality of life. The earlier an individual is exposed to health literacy skills the better for the person and the community.
Programs such as Head Start[65] and Women, Infants, and Children (WIC)[66] have impacted society, especially the low-income population. Head Start provides low-income children and their families early childhood education, nutrition, and health screenings. Health literacy is integrated in the program for both children and parents through the education given to the individuals. WIC serves low-income pregnant women and new mothers by supplying them with food, health care referrals, and nutrition education. Programs like these help improve the health literacy of both the parent and the child, creating a more knowledgeable community with health education.
Although programs like Head Start and WIC have been working with the health literacy of a specific population, much more can be done with the education of children and young adults. Now, more and more adolescents are getting involved with their health care. It is crucial to educate these individuals in order for them to make informed decisions.
Many schools in the country incorporate a health class in their curriculum. These classes provided an excellent opportunity to facilitate and develop health literacy in today's children and adolescents. The skills of how to read food labels, the meaning of common medical terms, the structure of the human body, and education on the most prevalent diseases in the United States should be taught in both private and public schools. This way new generations will grow with health literacy and would hopefully make knowledgeable health decisions.
Framework and potential intervention points[edit]
The National Library of Medicine defines health literacy as:[67]