Health literacy

Reading and frowning

Health literacy and health information producers

HL_report_front_coverHealth literacy is broadly about an individual’s ability to make sound health decisions in the context of everyday life and as such, it is an important aspect of their capacity to manage their health and care. Although it has a significant impact on health outcomes, it has had a relatively low profile in the UK compared to areas such as shared decision making, behaviour change and health improvement. Low health literacy compromises people’s ability to understand their health needs and to navigate complex healthcare systems, with profound consequences for their health. It is closely associated with significant health inequalities between different groups in the UK.

People with low health literacy have poorer health status, are less likely to make healthy living choices, experience higher rates of hospitalisation and emergency admissions and incur substantially higher health service costs. Low health literacy was once seen as an individual’s deficit – their lack of knowledge and skills regarding health issues. It is now recognised that health literacy is a ‘systems issue’, which reflects the complexity of both health information and the health care system. It represents a very significant problem and challenge in the UK. For example, around one in five adults cannot read or understand simple instructions or labels such as those found on medicine bottles.

Addressing health literacy issues is a fundamental part of the consumer health information challenge. Understanding and improving health literacy should be a key objective for anyone who works in the field of consumer health information or who communicates with the public in any way about their health.

In early 2013, PIF conducted a survey among information producers which sought to gain insight into health literacy from the information producer perspective; exploring whether information producers know what it means and how important they think it is; what specific strategies they have to address the needs of people with low health literacy and how these strategies are implemented.

347 organisations took part,  largely reflecting the make-up of the health information sector, with the majority of responses coming from NHS and voluntary sector organisations. The vast majority of information producers see health literacy as something that is relevant and important to everyone, rather than to specific groups of people. They believe that all resources should be clear, simple and straightforward in order to meet a wide range of health literacy needs.

Most respondents rated the issue of health literacy as extremely or very important when planning, developing or writing information resources or services. However, fewer than half provided services or resources that address the needs of people with low health literacy and only 10% had a specific policy or strategy. The main barriers faced when producing information for people with low health literacy include limited funds and resources, limited understanding of needs and limited understanding of how to develop appropriate resources or services. The findings show that although information producers in the UK have a good understanding of health literacy and its importance, they lack the tools and skills with which to develop appropriate resources and services that meet the needs of people with low health literacy. There is a clear appetite for practical guidance and case studies.  Find out more about the survey.

‘It’s not that we don’t want to produce information in this way; it’s how we go about it – the same with learning disabilities, there are no set guidelines to follow when producing information – there are symbols and pictures but no actual written help on how to word patient information.’ Survey respondent

What is Health Literacy?

It is now recognised that health inequalities arise from a combination of socio-economic factors experienced by many people living in areas of multiple deprivation.  Consequently those determinants of health such as education, employment, housing level of income, environment as well as ethnicity, not having English as a first language  and gender can impact on peoples ability to both understand and act on health promotion messages as well as function effectively in clinical settings.  This is backed up by studies in America which show that half of patients cannot understand basic healthcare information let alone act on it. This understanding, or lack of it, is known as Health Literacy.

Health Literacy has been defined 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.

Within this definition Health Literacy means more than being able to read pamphlets and successfully make appointments. By improving people’s access to health information and their capacity to use it effectively, health literacy is critical to empowerment. (World Health Organisation 2009).

Senior woman with medicine and laptop

People with low literacy levels may not understand how to take their medicines

A wider view of health literacy includes the ability to understand scientific concepts, content, and health research; skills in spoken, written, and online communication; critical interpretation of mass media messages; navigating complex systems of health care and governance; and knowledge and use of community capital and resources, as well as using cultural knowledge in health decision making (Nutbeam, 2000; Ratzan, 2001; Zarcadoolas, Pleasant, & Greer, 2002). This view sees health literacy as a social determinant of health that offers a powerful opportunity to reduce inequities in health.

This perspective defines health literacy as the wide range of skills, and competencies that people develop over their lifetimes to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks, and increase quality of life.

A further definition is offered by Nutbeam who speaks of Health Literacy as arising from the clinical care paradigm or from the Health Promotion paradigm. In the former it is a basic skill the lack of which is a ‘risk’ to the ability to achieve and maintain good health, in other words a deficit model. In the latter it is the outcome of Health Promotion activities and consequently an asset model. Nutbeam D, (2008)

Impacts of Low Health Literacy

Health Literacy can have a major impact with regard to how people self manage long term conditions. For example, in the area of Asthma when compared with people with adequate HL, people with low HL were more likely to have poorer knowledge of correct use of inhalers and more emergency room use according to an American study. Another American study demonstrated with regard to Diabetes Mellitus when compared with people with adequate HL, people with low HL were more likely to have more complications e.g. retinopathy, cerebro-vascular disease. From a preventative perspective when compared with people with adequate HL, people with low HL were less likely to have undergone cervical screening.

Low health literacy levels impact on a number of aspects of health for the individual, including knowledge, health status and use of health services. A 2006 report for the Health Foundation highlighted research which showed that patients with low health literacy are at greater risk of hospitalisation, are less likely to take medicines as prescribed, are less likely to make informed health decisions and may incur significantly higher healthcare costs.  On a practical level people with low literacy levels may not understand how to take their medicines, the need for cancer screening or the risks of surgery fully when they sign a consent form.

Top Tips

  1. Thumbs-upRemember that Health Literacy is about more than producing information – it is about ensuring people understand and can act on the information.
  2. Health Literacy impacts on people regardless of learning  or socio-economic status. Healthcare and the health service is complex and can be difficult to navigate and treatments can be complicated and change quickly. This means that there is a need for access to clear straightforward and understandable information which is tailored to our level of learning to make choices, learn about our health and self care
  3. Those people with the least well developed Language, Literacy and Numeracy skills (over 7 million in England according to Government research) are likely to have the lowest levels of Health Literacy.
  4. If someone has a long term condition they might be very health literate about that, but much less so if they have to function in a totally different and new health context.
  5. Health Literacy is not just a concern for clinicians it is of relevance to all healthcare staff who have a role in providing patients with information.
Acknowledgement: Community Health and Learning Foundation
Page last updated: 2/1/2018