Abstract
As attention to health literacy grows as an area for policy intervention,policy discourse continues to draw on skills deficit and patient compliance, buttressed by the dominant political discourse of individual responsibility. But for patients, the health domain is interwoven with linguistic challenges, significant affective issues, underlying cultural dimensions, political and economic exigencies, variable access to resources, and cognitive and situated complexity. From these perspectives, this article reports on findings of an ongoing study of health literacy demands in the Midlands region of the North Island of New Zealand, an area of high ethnic and socio-economic diversity.The study focuses on patients with diabetes and cardiovascular disease - two chronic areas strongly associated with ‘failure to care’ and identifed as having reached epidemic proportions. It analyses work to date:health professionals’ conceptions of and responses to perceived patients’ health literacy needs, and health information documents for patients. Implications of the study support the need for improvement in language and literacy skills among patients, but also the recognition of complexity and a collective responsibility for effective health communication.
Highlights
As attention to health literacy grows as an area for policy intervention, policy discourse continues to draw on skills deficit and patient compliance, buttressed by the dominant political discourse of individual responsibility
Health researchers have found low health literacy associated with poorer general health relative to patients with higher levels of health literacy (Adams, Appleton, Hill, Dodd, Findley, and Wilson 2009), more hospital admissions (Adams et al 2009, Paasche-Orlow and Wolf 2007), and poor management of chronic disease like diabetes (Osborn, Cavanaugh, Wallston, White, and Rothman 2009, Schillinger et al 2002)
Most of this work has been conducted within the health care sector, with patients’ comprehension of health information texts as the central focus
Summary
The health care sector has driven international attention to health literacy, with several widely accepted tenets. The recent New Zealand Ministry of Health publication, Kōrero Mārama: Health Literacy and Māori (2010) for example, is based on the findings of the most recent international literacy survey, Adult Literacy and Lifeskills (ALL) It highlights the large proportion of Māori with poor health literacy levels, that is, with ‘insufficient skills to cope with the health literacy demands they typically face’ (2010:9) and compares them to consistently higher non-Māori scores. More recently Papen and Walters’ (2008, 2009) research on the social practices of health literacy has contributed significantly to our understanding of health literacy’s social dimensions, by identifying a range of social factors that impact on health literacy and by acknowledging the importance of textual mediation of health care information They found health literacy practices to be embedded both in hierarchical social relationships with medical authority figures and in institutional processes. Disease domains and documentation, patient support, and the construction of patient identity
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