Understanding Health Literacy

Health literacy may be defined as:

The degree to which people are able to access, understand, appraise, and communicate information to engage with the demands of different health contexts to promote and maintain health across the life-course

Domains of health literacy
There are at least three important domains that make up aspects of an individual’s health literacy:

1. Functional health literacy: the ability to understand one’s own health issues, perform low skill tasks, or follow directions, especially in written materials or on labels. Individuals with poor functional health literacy often also have limited capacity to meet their needs in other areas of life.

What happens when having limited functional health literacy?
Persons with limited functional health literacy in general have problems to read, write or calculate. Most of them have not completed basic education or not maintained their skills later in life. In their daily life, they are not intellectually challenged and often have no or simple jobs. They may come from minority or immigrant groups that are marginalised in society and may live in isolation.

2. Interactive health literacy: the ability to ask questions and identify one’s own knowledge gaps. Poor interactive literacy means difficulties in explaining health problems or discussing them with health professionals. Someone with good interactive health literacy skills can easily communicate his/her health problem and discuss it, asking questions to obtain a better understanding.

What happens when having limited interactive health literacy?
Persons having problems with interactive health literacy may have little experience in the healthcare system; everything is new and to be discovered. They experience relations with health workers as hierarchical and unequal. They may be reluctant to ask questions because they do not want to “waste health workers time”. They may forget quickly what was said in the conversation when they are stressed and mentally blocked.

3. Critical health literacy: the ability to make informed health decisions in the context of everyday life – at home, in the community, at the workplace, in the health-care system. When people are critically health literate, they can seek out information, take responsibility for their health and with that have a sense of control over their health. Someone with poor critical health literacy skills may not be able to make his/her own decisions based on the knowledge and information available because of a lack of skills to critically appraise and evaluate that information. However, good critical health literacy could mean, for instance, knowing to consult friends, checking on the Internet for information or attending regular medical consultations: always appraising the value and reliability of each of these information streams.

What happens when having limited critical health literacy?
Taking the right decisions for health is not easy, even for experienced persons. Stress or difficult situations (e.g. being confronted with life-threatening conditions) make it difficult for anyone to make rational decisions. Emotions can run high and affect objective analysis of one’s health situation.

Addressing the individual’s weakness in any of these domains may require an understanding of the personal, environmental, political and socio-cultural factors that determine health. It is proven that low health literacy is related to poor health outcomes. Low health literacy can mean for instance an unhealthy diet, irregular use of cancer screening, missed vaccinations, or difficulty taking medicines appropriately. This then increases the chances of unnecessary hospitalisations, more emergency care use and poorer overall health status and higher mortality. Improving health literacy is seen as a key priority for enabling good health in Europe.

References
Kwan B, Frankish J, Rootman I, et al. The development and validation of measures of “health literacy” in different populations. UBC Institute of Health Promotion Research and University of Victoria Community Health Promotion Research 2006.

Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international 2000; 15(3): 259-67.

Kickbusch I, Maag D. Health Literacy. In: Heggenhougen K, Quah S, eds. International Encyclopedia of Public Health. San Diego: Academic Press; 2008: 204-11.

Organisation WH. Track 2: Health literacy and health behaviour. 7th Global Conference on Health Promotion: track themes; 2010; 2010.

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Annals of internal medicine 2011; 155(2): 97-107.

Kickbusch I. Improving health literacy in the European Union: towards a Europe of informed and active health citizens. Presentation delivered at the European Health Forum Gastein; 2004; 2004.