Adapting health literacy guidelines to specific contexts

When developing and implementing health literacy guidelines, policies and interventions, it is important to take contextual factors into account, as they play a key role in the initiation and maintenance of behaviors (see also: comprehensive approach more effective).

Social context

  • People’s social context consists of their social networks. The social network includes characteristics such as the composition of the household or home (e.g. multi-generation households, elderly homes) or number of friends. Other characteristics are the potential to rely on neighbours, family or peers for support (e.g. civic society organisations).
  • In IROHLA we found some evidence that the negative consequences of limited health literacy in older adults may be mitigated by social support and the availability of services.
  • Understanding the social context will help healthcare workers and social workers to develop and implement effective interventions that match people’s needs.
  • Understanding the social context will allow for quicker assessment and improvement of less successful interventions, so these are adjusted to better meet the needs of the target group.
  • Social participation is an influential factor. It refers to social activities like going to church, meeting friends or participating in a club. In this way, social participation can contribute to active and healthy ageing.

Socio-economic context

  • Patterns of socioeconomic circumstances can differ in a neighbourhood, region or country. For example, this refers to the percentage of adults with a low educational attainment, unemployment rate of (older) workers in a region, types of employment available, and levels of financial income.
  • In terms of health literacy: lack of opportunity to access education is likely to limit individuals’ ability to understand, appraise and use health information.

Cultural context

  • The cultural context refers to a set of values, beliefs and attitudes shared by most members of a society or community. This can be related to specific characteristics of the population (e.g. ethnicity, religion, tradition, language). Furthermore, cultural practices or learned behaviour patterns can be a characteristic of members of a community or society.
  • Culture is another important determinant of successful guidelines because cultural values and beliefs influence the way people look at, and perceive illness, health, and the need for healthcare or health information.
  • People with the same cultural background tend to look at the world through a similar cultural lens. This cultural lens, in combination with someone‘s own experiences, shapes their perceptions, and the way they interpret information. For example, the cultural lens of an older adult with relatively low education who has been living in a village for his or her whole life is likely to be different from that of a young medical specialist who just spent ten years in training in a university town. The ‘cultural lens’ of the medical specialist is shaped by fewer traditions, but more by his or her professional medical training. Successful health literacy guidelines pay attention to these differences in cultural lenses and incorporate cultural values as well as local customs.

Physical context

  • Elements of the physical context include physical quality of the housing and living environment of older adults. Physical factors include quality of housing, access to public amenities such as parks, proximity to shops and neighborhood safety .
  • It is important to take the local physical context into account when developing and implementing health literacy guidelines and policies.

Healthcare context

  • A good health system, according to WHO “delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well-maintained facilities and logistics to deliver quality medicines and technologies”.
  • The complexity of healthcare systems can make it hard for people to find their way and access information. It is thus important to simplify healthcare systems, to make health information more accessible and to improve interactions between healthcare professionals and service users.
  • In order to improve health literacy outcomes, it is important to coordinate and reconcile the demands and capacities of individuals, their context and the health system. Moreover, it is essential to consider the interaction between individuals and the health system. The IROHLA model also stresses this aspect, as it supports a comprehensive approach that targets multiple groups (individuals and their social environment as well as professionals and the health system using a variety of strategies).


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