Measuring health literacy: moving towards a health – promotion perspective

Abstract

unattended. Of course, questions on ‘how’ to measure health literacy are not independent of the more fundamental question on ‘what’ and ‘what for’ do we want to measure it. Those questions, I suppose, cannot be answered without some differentiation on the field of application, in other words, in what public health intervention areas health literacy is meant to be applied to.Usual answers to the ‘what for’ question revolve around public health objectives to improve people’s chances for good health. But then we ask: What dimensions of health do we want to improve and through what kind of interven-tion approach is health literacy supposed to contribute to that goal? Is it medically defined outcomes such as diabe-tes, hypertension and their risk factors or is it subjective wellbeing and social functioning? And, is it through medi-cal services or through lifestyle modifications that we want health literacy interventions to contribute to? In that, we need to consider that health literacy may have very differ-ent meanings and functions in contexts as divers as a short hospital stay and a long-term lifestyle modification. This clearly indicates that we need different measures of health literacy to cover the various fields of public health inter-ventions. A more differentiated look at medical services and health promotion as the two major fields of public health inter-ventions links the applied ‘how to measure’ question with theoretical considerations behind the ‘what for’ question. Applied to medical settings, the question on what we want to measure health literacy for is often answered by point-ing to an optimal utilization of medical services. The ra-tional there is that optimal or at least adequate use of medical services would depend on people’s abilities to read and understand medical information, be it in written form or conveyed in personal encounters such as doctors visits. Improving people’s understanding of what is pro-vided in the realm of medical services is seen as a major factor that contributes to increased quality of care and ad-herence to expert advice. Measurement of health literacy is needed to identify those patients that do not understand medical information or the range of services offered. Only if we know about those patients or subgroups with low de-grees of health literacy, we can adjust our services respec-tively or provide specific teaching programs for patients.Answers to the ‘how’ and ‘what for’ questions might be significantly different, if we take them on from a health promotion perspective. Health promotion approaches do not focus on illness experiences or optimal use of medical services. In health promotion the focus usually is much broader and emphasizes healthy general living conditions and people’s chances to live healthy lives. Moreover, health promotion calls for improving the resources people need in order to be active for their health, their own personal health, the health of their families and communities, in-cluding the power to change things for the better. In this perspective, health literacy refers to people’s knowl-edge about how health is maintained and improved in