Prevention: A Blueprint for Action. Health Literacy


The innovations produced by the healthcare and public health systems often are poorly matched with the day-to-day information and services that the public needs to lead longer, healthier lives.  This gap between what science has discovered and the public’s ability to put health information, messages and recommendations to appropriate use, may be explained in large part by limited understanding.  Prevention often requires individuals to understand the effects of their behavior.  Efforts to increase prevention often require significant resources.  Realizing the benefits of investments in prevention requires that individuals have the capacity to take responsibility for making health-related choices and that policy makers and health professionals take responsibility for supporting and coordinating the information, resources and programs that foster healthy behaviors and prevent disease.

It is critical that individuals have access to health information in a way they can understand to make appropriate health decisions.  The corollary is that health professionals must provide useful information and be able to communicate clearly and effectively.  The ability to access, understand and apply health information is known as “health literacy.”  Information encompasses traditional print brochures, discussions between patients and healthcare providers, public health messages on the Internet, television and other mass media, instructions on food and medication labels, and forms to apply for insurance programs or provide informed consent.  Efforts to promote health literacy continue to evolve. 

The basic definitions of literacy and health literacy are widely known and generally agreed upon. The National Literacy Act of 1991 defines functional literacy as  

The ability to read, write, speak, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.

The following definition of health literacy was first used in a 1999 National Library of Medicine bibliography. It has since been widely adopted, and adapted. 

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.     

Health literacy is not a set of skills specific to a health topic but basic communication capacities that consumers, patients, and providers bring to bear on many different types of health situations.  The core of the health literacy concept is “understanding,” and the core of the health literacy problem is the mismatch between the public’s functional health literacy and the complexity of health terminology, recommendations, instructions, forms, healthcare systems and public health services.  The mismatch is even more critical for individuals with limited literacy skills and multiple health conditions.  Too often they have the greatest health burdens, limited access to relevant health information and limited abilities to understand the information.

The concept of health literacy derives from the general idea of literacy as a set of functional skills that are applied in different situations or contexts.  Thus, “health literacy” is typically described as literacy in health settings.  There has not been sufficient research, however, to determine if health situations or contexts require skills in addition to or different from those described as basic literacy skills.  Moreover, the research literature as well as HHS’s program operations and research projects indicate that “health literacy” refers not only to an individual’s or group’s capacities to understand information but also to their knowledge of a specific set of health-related facts, e.g., the acceptable range for blood pressure, the number and types of fruits and vegetables that a person should eat every day, or the frequency of a medication dose.  The Agency for Healthcare Research and Quality (AHRQ) recently released a report on Literacy and Health Outcomes that provides new information on health literacy skills.

Currently, national data on general literacy skills are used to assess health literacy.  Data from the 1992 National Adult Literacy Survey (NALS) from the U.S. Department of Education indicate that approximately one-half of the adult English-speaking population has what researchers consider “limited literacy skills.” [37]  HHS collaborated with the Department of Education to develop a module on health literacy for the 2003 National Assessment of Adult Literacy, that will provide the first-ever population-based assessment of health literacy.  The data from this national population sample will be available in 2005.

Consumers and patients increasingly manage their own health.  Reading, writing, speaking, listening, and interpreting proficiencies are necessary to interact with the modern health care system.  Moreover, health treatment and prevention services are more effective if they are geared toward different literacy levels and native languages, life stages, and nature and severity of illnesses.  Health literacy is broader than general reading and writing skills, and includes abilities to: comprehend quickly “on your feet,” comprehend complex vocabulary and concepts relevant to health (e.g., medical terms or probability and risk), share personal information with providers about health history and symptoms, make decisions about basic healthy behaviors, such as healthy eating and exercise, and engage in self-care and chronic disease management.  These health literacy skills enable consumers to identify and understand health risks, evaluate different health promotion, treatment, and intervention options, and follow specific health care recommendations.

Health care providers and health information professionals need to communicate effectively with individuals with a variety of skills, from those with limited levels of understanding to those who have the skills to comprehend complex information and recommendations.  Limitations and a mismatch of skills on both sides can hamper the effectiveness of prevention messages, health information, and health care.

The nation's estimated 90 million adults with lower-than-average reading skills are less likely than other Americans to get potentially life-saving screening tests such as mammograms and Pap smears, to get flu and pneumonia vaccines, and to take their children for well child care visits, according to the recently released AHRQ literacy report.  Research suggests that the consequences of low health literacy are poorer health because consumers, patients and their families are less likely to understand how to prevent disease and disability, and to benefit from health care advances. Research has linked limited health literacy with poorer self-management of chronic diseases [38-40]; less knowledge of healthy behaviors [41-44]; higher rates of hospitalizations [45, 46]; and overall poorer health [47, 48].  Low literacy also plays an important role in health disparities and may contribute to lower quality care and even medical errors.

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