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by Madalina Saracutu
At the end of this presentation, you will be able
v demonstrate a basic understanding of the
concept of health literacy.
v communicate the importance of health literacy
to colleagues and patients.
v identify specific ways to integrate health
literacy into your work.
v What is health literacy and why is it important?
v How does health literacy relate to health outcomes?
v Integrating health literacy into your work
v Future research
Early definitions More recent definitions
The ability to apply reading and
numeracy skills in a healthcare
(USA National Adult Literacy
Survey, Kirsch et al.,1993)
The ability of individuals to access
and use health information to make
appropriate health decisions and
maintain basic health.
(Murray et al.,2007)
A constellation of skills, including
the ability to perform basic reading
and numeracy skills required to
function in a healthcare
(Ad Hoc Committee on Health
The ability to access, understand,
evaluate, and communicate
information as a way to promote,
maintain and improve health in a
variety of settings across the life
(Rotman & Gordon- El- Bihbety, 2008)
What is Health Literacy?
Levels and domains (Nutbeam, 2000)
v Functional health literacy- basic reading and writing skills
necessary to function effectively in the healthcare context
v Interactive health literacy- development of personal skills
in a supportive environment aiming to improve personal
v Critical health literacy- ability to critically evaluate and use
information to actively participate in health promotion
Why Is Health Literacy Important?
Navigating the healthcare
Sharing personal and
Acting on health related
Fig.2 Causal pathways between limited health literacy and health outcomes
(Paasche-Orlow & Wolf, 2007)
v De Walt et al.(2004) - patients with low HL tend to have poorer
health outcomes; follow-up: children with low HL had worse health
behaviours and outcomes (De Walt & Hink, 2009).
v Sanders et al.( 2009)- after adjusting for SES, adults with low HL
1.2-4 times more likely to exhibit health behaviours that negatively
affect children s health
v HL associated with adherence- low HL may cause difficulties with
identifying medications or interpret prescription labels (Kolm &
v Patients with low HL tend to be reluctant to seek assistance due
to the stigma and shame (Baker & Pitkin,1996)
“I had some papers, but I didn't know they were
prescriptions and I walked around for a week
without my medication. I was ashamed to go
back to the doctor, but a woman saw the
papers I had and told me they were
prescriptions. It's bad to not know how to
read. After getting my medicine I had to
come back and ask how to take them
because I was urinating too much. They told
me I was taking double the medication I was
supposed to. I had two bottles and I was
taking one from each bottle, but it turned out
they were the same medication. But since I
don't know how to read, I didn't know “
v Rapid Estimate of Adult Literacy
in Medicine (REALM)- Davis et al.,(1993)
v Wide Range Achievement Test
(WRAT) - Jastak & Wilkinson (1993)
v Test of Functional Health Literacy in Adults
(TOFHLA)- Parker et al., (1995)
v The Newest Vital Sign (NVS) - Weiss et al.,( 2005)
v Literacy Assessment for Diabetes (LAD) –
Nath et al., (2001)
11Sample REALM test
What does REALM test
assess? Can you identify
any issue with this test?
Issues with measurement
v HL measures based on
functional literacy do not
capture the full range of
skills needed for HL
v Current assessment tools cannot
– Reading ability
– Lack of health-related
– Lack of familiarity with
language and materials
– Cultural differences in
approaches to health.
Strategies to improve
communication and health literacy
v Slow down
v Use plain, non-medical
v Show or draw pictures
v Limit the amount of
v Test for readability
(Word , Show readability
v Use the teach-back
v Create a shame-free
v Consider using the Ask-Me-3
What is my main problem?
What do I need to ?
Why is it important for me to do
Make a case for improving health
v Identify specific programs
and projects affected by
limited health literacy.
v Target key opinion
leaders with health
Explain how health
relates to your mission,
goals, and strategic
research and reports
on health literacy to
Post and share health
v 776 mill. adults who lack basic
literacy skills, 516 mill. women
Unequal access to literacy
coexists with other social
e.g. US risk of low literacy:
immigrants, racial and ethnic
groups, 65+ with limited
communities (Marks, 2009)
The six Dakar goals
The Dakar Framework for Action, Education for All: Meeting our Collective Commitments adopted by the
World Education Forum (Dakar, Senegal, 26 –28 April 2000), Paris, UNESCO, 2000.
v Expanding health literacy
v More research on the
application of health
literacy in other contexts
v Development of
creative approaches to
promote health literacy
v More rigorous evaluations
and evidence of good
practice on health literacy
Health Literacy: Learning is the best
Health Literacy: Healthy Living
1-day Conference at Keele Hall, Keele University
Friday 20th June 2014
Join us for our 3rd
Health Literacy Research Conference
Health literacy is ‘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’.
We have plenary sessions from national and
international health literacy experts, including Dr
Michael Wolf (Northwestern University, Chicago) Dr
Kristine Sorensen (Maastricht University) and Prof Gill
Rowlands (Kings College, London).They will present
their view on the current evidence, impact and future
implications of Health Literacy Research on Healthy
Living, from their respective international perspective
of the US, Europe and the UK.
We welcome applications for oral presentation or
posters on Health Literacy research and development
or innovative and exciting Health Literacy practices.
The abstract submission guidelines are available from
the website www.healthliteracy.org.uk or from Sue
Abstract deadline 5pm 21st
Delegate rate for full day including tea, coffee and
lunch £90. Please contact Sue Weir as above.
Dr Joanne Protheroe
Co-Chair Health Literacy Group UK
We are currently in negotiation with the Journal of Communication in
Healthcare for a special issue to cover the conference presentations.
For more information about the Journal, visit
Professor Michael Wolf - Professor of Medicine
and Learning Sciences, he founded and
continues to lead Northwestern’s Health Literacy
and Learning Program (HeLP). He is a health
services researcher and cognitive/behavioral
scientist with expertise in adult literacy and
learning in healthcare, patient education,
medication safety and adherence, and the use of
health technologies to support chronic disease
Dr Kristine Sorensen - is a health literacy expert
and project coordinator of the European Health
Literacy Project (HLS-EU) hosted by the
Department of International Health at Maastricht
University. Other related projects are the
Collaborative Venture on Health Literacy and the
Diabetes Literacy Project supported by the
Professor Gill Rowlands - is a health literacy
expert at Kings College, London. She recently
led a large national (UK) project examining the
health literacy skills of the population and the
health materials that they are expected to make
Health Literacy: Prescription to End Confusion (2004) Lynn
Nielsen-Bohlman, Allison M. Panzer, David A. Kindig, Editors,
Committee on Health Literacy
Baker, D.W., Pitkin M.V (1996) the healthcare experience of patients with low literacy. Archive of Family Medicine, 5,
DeWalt DA, Berkman ND, Sheridan SL, Lohr KN, Pignone M. Literacy and health outcomes: a systematic review of the
literature. Journal of General Internal Medicine. 2004; 19(12): 1228 –1239.
De Walt D.A. & Hink A. (2009) Health literacy and child health outcomes: a systematic review of the literature. Paediatrics,
“Health Literacy: Learning is the best medicine”. (2010). [Video] Toronto:
Kirsch, I., Junglebut, A., Jenkins L., Kolstad, A. (1993) Adult literacy in America: A first look at the results of the National
Adult Literacy Survey. Washington DC: National Center for Education Statistics, US Department of Education.
Murray S., Rudd R., Kirsch I., Yamamoto K., Grenier S. (2007) Health literacy in Canada, initial results from the
International Adult Literacy and Skills Survey, Ottawa: Canadian Council on Learning.
National Assessment of Adult Literacy (2003). National Center for Education Statistics (NCES)
Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and
communication strategies in the 21st century. Health Promotion international, 15, 259-267
Paasche-Orlow, M.K & Wolf M.S. (2007) The causal pathways linking health literacy to health outcomes. American Journal
of health Behaviour, 31, S19-26.
Sanders L.M., Federico S., Klass P., Abrams M.A. & Dreyer B. (2009) Literacy and child health: A systematic review.
Archive of Paediatric and Adolescent Medicine, 163, 131-140
UNESCO (2000). Wef (NGO consultation). [Online]
Retrieved from: http://www.unesco.org/education/wef/en-conf/dakframeng.shtm [Accessed: 6 Mar 2014].