Health literacy

Origin and terminology

Health literacy is a concept that has been increasingly explored and debated since the end of the 1990s and it has found much interest at policy-making level. Behind this development is the increasingly complex health care system with an ever widening range of products, services and treatment options and the most varied information from different sources. Potential users of the health system are confronted with a plethora of sometimes conflicting information. Particular skills and knowledge are required in order to make sense of the mass of information. This set of necessary knowledge and skills is called 'health literacy'.

Health literacy is a recent concept and its terminology is still inconsistent. Most often health literacy is defined as the ability to obtain, process and understand health information and to implement it in everyday life. Somewhat broader is the following definition: "Health literacy is the ability of individuals to make decisions which have a positive impact on their own health and on the health of others."

Different orientations

The concept of health competence may be divided into two main perspectives with different roots and origins. One has its roots in the clinical environment and is also known as 'medical literacy' or 'patient health literacy'. In this context, health literacy describes the competencies that a patient needs to read, to understand and to act on information.

The other perspective is a more oriented towards public health. It corresponds to the broader vision of public health and is thus defined more comprehensively. It aims to empower or authorize people to make their own decisions and free choices regarding their health. This understanding of health literacy is not only about cognitive skills but includes extensive social and cultural skills that can be strengthened by the empowerment approach.

A model for health literacy

Different models exist for the categorization of health literacy. The most famous is by Don Nutbeam, which distinguishes three levels:

  • Functional health literacy describes basic skills needed for reading and understanding health information and for the use of services.
  • Communicative, interactive health literacy includes cognitive and social skills, making it possible to deal actively with information and translate it into action.
  • Critical health literacy describes advanced cognitve and social skills enabling critical analysis and critical use of information.

In empirical studies mostly functional health literacy has been scrutinized so far. Study designs which include all three levels are still lacking.

Challenges

Existing studies show discrepancies between the high demands that are made in the health care system and the existing skills in different population groups. .Research in the U.S. also points out that a lack of health literacy generates additional health costs.

In order to translate these results into health promotion practice, a common base is needed, starting with terminology, models and corresponding appropriate measurement tools. Equally important is a clearer distinction between the clinically and the public-health oriented perspectives and definitions of health literacy.

It should be noted that health promotion and prevention projects by definition include the acquisition of competencies (which is a prerequisite for more control over one's health). This is achieved by using working methods which systematically apply empowerment and participation approaches in settings and target groups.

Bibliographical references

  • Kickbusch, I.; Maag, D.; Saan, H. (2005). Enabling healthy choices in modern health societies. Badgastein: European Health Forum.
  • Nielsen-Bohlman et al (ed.) (2004). Health literacy. A prescription to end confusion. Institute of Medicine (US). Committee on Health Literacy. Washington: The National Academies Press.
  • 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, Vol. 15, No. 3, 259-267, September 2000.

Why you would disregard these aspects

  • You have not yet studied the concept of health literacy.
  • The sophisticated concept of health literacy is difficult to implement in specific projects.

What you have to gain

It is a central goal of health promotion to enable individuals to gain more control over their own health. If you include core elements of health literacy in your project you contribute to promoting significant health-related skills and competencies.

What you can actually do

  • Study the concept of health literacy.
  • Check which skills already exist in the target group and which ones can be developed in addition to those.

Questions for critical reflection

  • Do you have an idea of how you can actually use the health skills concept in practice?
  • What are the competencies you consider as central for the setting or for the target group in your project and how can you actually improve them?
  • How do you want to convey specific health skills?