Definition Of Health Literacy Research Articles

Building the health news agenda in local newspapers: Lessons for health-care managers

Health news is a significant source of health information for many Americans, and recent research has explored how health news is produced from the theoretical perspective of agenda building. In addition, work in public health and mass communication has focused on the significance of the health literacy concept as a tool for journalists and as a rubric for evaluating media messages. However, little is known about health news agenda building or health literacy in relation to local newspapers. This study explores the health news agenda-building process from the perspective of both newspaper journalists and administrators from local public health organizations in one Midwestern state through online and telephone surveys. Results show that public health professionals and journalists offer significantly different definitions of health literacy and interpretations of what should constitute the health news agenda.

Health literacy – a heterogeneous phenomenon: a literature review

A growing responsibility on the part of individuals to make decisions in health issues implies the need of access to health information and personal skills to comprehend the information. Health literacy comprises skills in obtaining, understanding and acting on information about health issues in ways that promote and maintain health. A lack of health literacy may have effects at both the individual and societal levels. There are thus reasons for health care professionals to gain a comprehensive understanding of health literacy. The aim of this review was to explore how health literacy is described in the scientific literature and to give a synthesis of its different meanings. The review was based on approximately 200 scientific articles published 2000-2008. The analysis process was inspired by the methods of narrative literature review. Two different approaches to health literacy became visible, one in which health literacy is expressed as a polarized phenomenon, focusing on the extremes of low and high health literacy. The definitions of health literacy in this approach are characterized by a functional understanding, pointing out certain basic skills needed to understand health information. The other approach represents a complex understanding of health literacy, acknowledging a broadness of skills in interaction with the social and cultural contexts, which means that an individual's health literacy may fluctuate from one day to another according to the context. The complex approach stresses the interactive and critical skills needed to use information or knowledge as a basis for appropriate health decisions. We conclude that health literacy is a heterogeneous phenomenon that has significance for both the individual and society. Future research will aim at the development of assessments that capture the broadness of skills and agents characteristic for health literacy as a complex phenomenon.

Health Literacy: A Survey of the Issues and Solutions

Health literacy has been recognized as a pressing issue in providing good health care and holding down health care costs. This article presents various definitions of health literacy, enumerates the statistics and demographics of this significant global issue, provides a survey of the literature with links to the most authoritative Internet resources, and discusses the role the medical library community must take to address the subject of health literacy, especially as it relates to health care professionals. Selected fundamental online resources and literature on this vital topic are reviewed, with links to relevant sources.

A Canadian exploratory study to define a measure of health literacy

This study undertook a qualitative exploration of an operational definition of health literacy and an examination of quantitative measures of health literacy skills. We interviewed 229 older Canadian adults. First we engaged them in open-ended discussions about their search for information on a self-selected health topic. Next we administered nine self-report items on health literacy skills, and then task-performance items. Task-performance questions were based on two published reading passages on five levels of difficulty to measure 'understanding' of health-related material. The Rapid Estimate of Adult Literacy in Medicine (REALM) was also administered as the comparison for criterion-related validity. Our open-ended questions elicited responses about the processes that people undergo when they attempt to access, understand, appraise and communicate health information. Qualitative findings revealed complexities in participants' interpretation of the meaning of all four health literacy skills. These descriptive findings add new knowledge about health literacy as a construct. Participants agreed with most of the self-report statements, thus indicating high belief in their own health literacy. REALM scores ranged from 45 to 66 with an average of 65 and standard deviation of 2.5. Quantitative scores on the reading passages were modestly correlated with scores on the REALM. The sum scale of self-report items, however, did not correlate with task-performance items, suggesting that the different types of items may not be measuring the same construct. We suggest that self-report items need more development and validation. Our study makes a contribution in exploring the complexities of measuring health literacy skills for general health contexts.

Quantifying Word Use to Study Health Literacy in Doctor–Patient Communication

Most health literacy research to date has assessed health literacy using either general reading tests or text-based appraisals of reading and numeracy skills, yet the definition of health literacy includes domains beyond reading ability. Effective oral communication between doctor and patient is an important component of health literacy, but only recently have efforts been made to develop measures that tap into domains beyond those that can be assessed with text-based measures. Focusing on oral exchange, this article describes computer-assisted approaches to quantifying word use and the development of three word-use measures that can be used to study health literacy in transcripts of clinical encounters. The measures can be used to assess either the expressed literacy level of patients or the aural literacy demands made by doctors. Importantly, the computer-assisted quantitative measures described here make it possible for word use to be analyzed at a level of detail that human raters would be hard pressed to attain.

Health Literacy Issues Among Women with Visual Impairments

The purpose of this secondary analysis using qualitative description was to explore health literacy using the health care experiences of women with permanent visual impairments (VIs). Interviews were analyzed from a sample of 15 community-dwelling women ages 44 to 79 with permanent VIs who had participated in a larger grounded theory study. The 15 women were interviewed twice; the audio-recorded interviews were then transcribed verbatim and analyzed using qualitative content analysis. Using the Institute of Medicine's definition of health literacy, the women's experiences were categorized into their ability to obtain, process, and understand health information. Their perceptions of the factors that influenced their health literacy were also explored. The women voiced that barriers to their ability to gain information in a format amenable to their processing skills, combined with barriers arising from health care providers' attitudes, undermined their ability to build health literacy capacity.

Health literacy and health communication

Health communication consists of interpersonal or mass communication activities focused on improving the health of individuals and populations. Skills in understanding and applying information about health issues are critical to this process and may have a substantial impact on health behaviors and health outcomes. These skills have recently been conceptualized in terms of health literacy (HL). This article introduces current concepts and measurements of HL, and discusses the role of HL in health communication, as well as future research directions in this domain. Studies of HL have increased dramatically during the past few years, but a gap between the conceptual definition of HL and its application remains. None of the existing instruments appears to completely measure the concept of HL. In particular, studies on communication/interaction and HL remain limited. Furthermore, HL should be considered not only in terms of the characteristics of individuals, but also in terms of the interactional processes between individuals and their health and social environments. Improved HL may enhance the ability and motivation of individuals to find solutions to both personal and public health problems, and these skills could be used to address various health problems throughout life. The process underpinning HL involves empowerment, one of the major goals of health communication.

Health Literacy and Children: Introduction

In the setting of increased interest in health literacy, the American Academy of Pediatrics (AAP) convened a national conference on health literacy and pediatrics in Washington, DC, on November 8, 2008: “A Health-Literate America: Where Do Children Fit In?” The purpose of the conference was to examine health literacy related issues, problems, and opportunities with reference to children and children's health. Most health literacy research and interventions have focused on adult patients and diagnoses, and this gathering—which brought together pediatricians, health literacy researchers, educators, health systems researchers and policy makers, and adult learners—was designed to address complex questions related to where children fit in a national health literacy agenda. Themes of the conference that run through this collection of commissioned articles, which were presented at the conference and are published in this supplement to Pediatrics , identify some of the ways in which children are distinct from adults regarding issues of health literacy while reminding us of how they are also part of the larger health literacy picture. The challenge of including children in a “health-literate America” is necessarily part of the overall challenge of addressing health literacy. The goals for children and their adult caregivers are the same as for adults: to use the health literacy perspective and its insights and evidence base to enhance the health care system, increase access and inclusion, reduce disparities, and improve health outcomes. This supplement to Pediatrics includes a systematic review by DeWalt and Hink1 of the literature on health literacy and child health outcomes, including analysis of methodology, discussion of the parent-child dyad, and opportunities for studying new interventions as they are developed. Wolf et al,2 in their article, observe the relationship between health literacy and health learning, offer a broadened definition of health literacy, and emphasize … Address correspondence to Benard P. Dreyer, MD, New York University School of Medicine, Department of Pediatrics, 550 First Ave, NBV 8S4-11, New York, NY 10016. E-mail: bpd1{at}nyu.edu

Considering Children and Health Literacy: A Theoretical Approach

The theoretical approaches of Paulo Freire, Jean Piaget, and Lev Vygotsky frame the consideration of children and health literacy. This article includes a general discussion of literacy from the Freirian perspective. A definition of health literacy is then presented; first, the established meaning is introduced, but then a Freirian extension is proposed. Next, the theories of cognitive development by Piaget and Vygotsky are discussed, and examples related to children's health literacy are given. Finally, there is a discussion of why it is important to encourage and enable health literacy among children and adolescents.

Literacy and Learning in Health Care: FIGURE 1

The relationship between literacy and health outcomes are well documented in adult medicine, yet specific causal pathways are not entirely clear. Despite an incomplete understanding of the problem, numerous interventions have already been implemented with variable success. Many of those who proposed earlier strategies assumed the problem to originate from reading difficulties only. Given the timely need for more effective interventions, it is of increasing importance to reconsider the meaning of health literacy to advance our conceptual understanding of the problem and how best to respond. One potentially effective approach might involve recognizing the known associations between a larger set of cognitive and psychosocial abilities with functional literacy skills. Here we review the current health literacy definition and literature and draw on relevant research from the fields of education, cognitive science, and psychology. In this framework, a research agenda is proposed that considers an individual's "health-learning capacity," which refers to the broad constellation of cognitive and psychosocial skills from which patients or family members must draw to effectively promote, protect, and manage their own or a child's health. This new, related concept will lead, ideally, to more effective ways of thinking about health literacy interventions, including the design of health-education materials, instructional strategies, and the delivery of health care services to support patients and families across the life span.

Overview and Summary: Promoting Health Literacy: Strategies for Healthcare Providers

Citation: Ludwick, R., (Sept. 30, 2009) Overview and Summary. Promoting Literacy: Strategies for Healthcare Providers OJIN: The Online Journal of Issues in Nursing\Jo\. 14, No. 3, Overview. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Voll42009/No 3Sept09/Overview-and-Summary-Health-Literacy.aspx Three years ago my husband was diagnosed with esophageal cancer; at that time he was not health literate. The signs of both esophageal cancer and health literacy can be subtle. Both have serious consequences if they remain undetected. However, esophageal cancer is immediately recognized as dangerous because cancer is frequently considered a life and death matter that needs immediate intervention. In contrast, low health literacy is generally not recognized as dangerous. Although the incidence of esophageal cancer is increasing, it remains a relatively rare cancer. In contrast, as Egbert and Nanna note in their article, 88 percent of Americans have some deficiency in health literacy (White, 2008). Thus low health literacy is a common issue that impacts us both professionally and personally as we care for and advise our patients as well as our family and friends regarding their health issues. Today my husband is cancer free and he has increased his health literacy level immensely. He is able to explain his symptoms, monitor and re-order medications, manage lists of questions for his appointments, ask for clarification from his providers, reconcile the list of medications he takes regularly on his follow-up visits, and make informed decisions about his health and treatment plans. Recognizing his previous health-knowledge limitations, my husband said to me while hospitalized after his esophagectomy, It's important you are studying health literacy. I didn't know what I didn't know. In a like manner I am glad that this issue of OJIN is devoted to health literacy, a concern that nurses, as individuals and as professionals, can do so much about. Although it will take the wisdom and skill of professionals in many disciplines to address the problem of low health literacy, nurses are in key positions to address this problem. Nurses working in clinical, educational, administrative, research, and political positions will all be needed to increase health literacy in the United States (US) and around the world. Join me in reading these articles that emphasize individual, person-centered health literacy efforts and recognize the broader issues of health literacy within our society, noting the unique contributions nurses can make at every level of healthcare. These introductory articles addressing healthcare literacy articulate the extent of the problem of low health literacy, clarify the concept of health literacy, and offer concrete suggestions for increasing health literacy. These rich articles will be of value across roles and settings whether you are a nurse, or other professional, seeking to address this common, yet elusive, and often hidden, problem of low health literacy. The article, Health Literacy: Challenges and Strategies, by Egbert and Nanna provides a strong introduction to the topic of health literacy, presenting the historical development of the current emphasis on health literacy and providing common definitions of health literacy. Using the framework of the Institute of Medicine's (IOM's) definition of health literacy, the authors discuss the challenges of obtaining, processing and understanding, and using health information, and offer strategies to overcome these challenges. Implications for both practice and research are emphasized. Recognizing that health illiteracy is a broad problem, one not solved at the individual or the disease level, the authors suggest examining health literacy from a social capital perspective and examine the networks and relationships that can build and sustain the health literacy of a population. …

Health Literacy: Challenges and Strategies

Although health literacy is a concept new to many members of the healthcare community, it has quickly caught the attention of researchers, policy makers, and clinicians due to its widespread impact on health and well-being. Despite the enormous implications of low health literacy, there remains a significant amount of confusion surrounding the concept and its connection with healthcare outcomes. The purpose of this article is to outline the scope of low health literacy as a concept and explore ways that researchers and clinicians can reduce its negative impact on health outcomes. First, the major definitions of health literacy are presented in a brief overview. Then, the concepts of obtaining, processing/understanding, and using information serve as a working framework for discussing both the challenges of low health literacy and strategies to address low health literacy. The authors conclude by identifying areas of research that are needed to advance the conceptualization of health literacy.

Tacit Understandings of Health Literacy

This research offers both qualitative and quantitative data about how health journalists approach health literacy practically and conceptually. Using interviews with 20 writers and editors for magazines and newspapers coupled with a national survey ( N = 396), this analysis uncovers journalistic techniques and tacit theories for making information understandable. The journalists evince a basic understanding of how health literacy can be enhanced through certain story elements (such as nontechnical word use), but they also maintain false ideas about appropriate comprehension aides (such as statistics). Findings show that journalists struggle to maintain scientific credibility while accommodating different audience literacy levels. Journalists’ definitions of health literacy strategically carve out a place for their work as translators.

Health literacy: setting an international collaborative research agenda

BackgroundHealth literacy is an increasingly important topic in both the policy and research agendas of many countries. During the recent 36th Annual Meeting of the North American Primary Care Research Group, the authors led an audio-taped 3-hour forum, "Studying Health Literacy: Developing an International Collaboration," where the current state of health literacy (HL) in the United States (US) and United Kingdom (UK) was presented and attendees were encouraged to debate a future research agenda.Discussion of Forum ThemesThe debate centred around three distinct themes, including: (1) refining HL definitions and conceptual models, (2) HL measurement and assessment tools, and (3) developing a collaborative international research agenda. The attendees agreed that future research should be theoretically grounded and conceptual models employed in studies should be explicit to allow for international comparisons to be drawn.Summary and Authors ReflectionsThe importance of HL research and its possible contribution to health disparities is becoming increasingly recognised internationally. International collaborations and comparative studies could illuminate some of the possible determinants of disparities, and also possibly provide a vehicle to examine other research questions of interest.

Bilingual health literacy assessment using the Talking Touchscreen/la Pantalla Parlanchina: Development and pilot testing

Objective Current health literacy measures are too long, imprecise, or have questionable equivalence of English and Spanish versions. The purpose of this paper is to describe the development and pilot testing of a new bilingual computer-based health literacy assessment tool. Methods We analyzed literacy data from three large studies. Using a working definition of health literacy, we developed new prose, document and quantitative items in English and Spanish. Items were pilot tested on 97 English- and 134 Spanish-speaking participants to assess item difficulty. Results Items covered topics relevant to primary care patients and providers. English- and Spanish-speaking participants understood the tasks involved in answering each type of question. The English Talking Touchscreen was easy to use and the English and Spanish items provided good coverage of the difficulty continuum. Conclusion Qualitative and quantitative results provided useful information on computer acceptability and initial item difficulty. After the items have been administered on the Talking Touchscreen (la Pantalla Parlanchina) to 600 English-speaking (and 600 Spanish-speaking) primary care patients, we will develop a computer adaptive test. Practice implications This health literacy tool will enable clinicians and researchers to more precisely determine the level at which low health literacy adversely affects health and healthcare utilization.

The Medical Library Association Guide to Health Literacy

The Medical Library Association Guide to Health Literacy

Health Literacy and the Role of the Speech-Language Pathologist

This article reviews concepts of health literacy and discusses the role of speech-language pathologists in improving the health literacy of individuals with and without communication disorders. A literature review was completed of health literacy definitions, concepts, and health literacy assessment and intervention studies with various populations. A literature review was also conducted regarding health literacy or related studies in the field of speech-language pathology. There is a paucity of information available on health literacy within the field of speech-language pathology. Suggestions are offered regarding increasing health literacy research and intervention by speech-language pathologists.

Health literacy: A concept/dimensional analysis

The terms "health" and "literacy" form a powerful concept that has evolved from the 1970s to one that has garnered the attention of a wide range of disciplines; most notably, education and health care, but also library science, public health, and the mental health arena. There are many definitions of health literacy, but none that encompass the totality by which the concept is constructed. This paper presents an analysis of the concept of health literacy using the technique of concept/dimensional analysis. A clear understanding of the concept is essential as health literacy has implications that are far-reaching and impact both the individual and society.

Patient health literacy and participation in the health‐care process

Health information is an important resource for patients to understand and engage in the management of their health conditions. We discuss the role of health literacy (HL) in improving patient participation and propose future research in this field. Literature searches were conducted to review existing definitions and measures of HL and identify empirical findings of its impact on patient health/illness-related behaviours. We searched MEDLINE using 'health literacy' as a keyword and retrieved 371 articles published in English between 1985 and 2006. We also hand-searched publications of leading researchers and related institutes and followed the reference lists of relevant articles. The World Health Organization has defined HL as 'the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.' Based on this definition, three levels of HL have been described: functional, communicative and critical. Studies of HL have increased dramatically over the past few years, but there is a gap between the conceptual definition of HL and its application. Thus, empirical evidence of its impact on patient health/illness-related behaviours is still limited. The prevalence and consequence of inadequate HL as fully defined have not been determined. Further research is needed to develop measures of HL beyond the functional level and that consider the interaction of the individual patient HL with the health and social contexts in which the patient lives.

Measuring Functional, Communicative, and Critical Health Literacy Among Diabetic Patients

Health literacy (HL), the capacity of individuals to access, understand, and use health information to make informed and appropriate health-related decisions, has been recognized as an important concept in patient education and disease management. This study examined the psychometric properties of newly developed scales for measuring three different levels of HL (i.e., functional, communicative, and critical) in patients with diabetes. The reliability and validity of the three HL scales were evaluated in a sample of 138 outpatients with type 2 diabetes. In addition, sociodemographic and clinical characteristics, knowledge of diabetes, information-seeking behaviors, and self-efficacy were assessed for each patient through a self-report questionnaire and review of electronic medical records. Scale items were constructed to directly reflect the definition of HL. Internal consistency of functional, communicative, and critical HL scales was adequately high (alpha = 0.84, alpha = 0.77, and alpha = 0.65, respectively). Three interpretable factors were identified in exploratory factor analysis. Correlations between HL scales and other measures supported the construct validity of the scales. The three HL scales were only moderately correlated with each other, suggesting that each represents a different domain of HL abilities and skills. Our newly developed HL scales are reliable and valid measures of three types of HL in diabetic patients. Exploring a patient's HL levels may provide a better understanding of the patient's potential barriers to self-management of disease and health-promoting behaviors.