Elsevier

Social Science & Medicine

Volume 67, Issue 12, December 2008, Pages 2072-2078
Social Science & Medicine

The evolving concept of health literacy

https://doi.org/10.1016/j.socscimed.2008.09.050Get rights and content

Abstract

The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots – in clinical care and in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical “risk”, or a personal “asset”. In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization. The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health.

The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness. These include more personal forms of communication and community based educational outreach. It recommends improved interaction between researchers working within the two health literacy perspectives, and further research on the measurement of health literacy. The paper also emphasizes the importance of more general strategies to promote literacy, numeracy and language skills in populations.

Section snippets

Literacy and health

Poor literacy skills among adults are surprisingly common in developed countries. Estimates of the proportion of the population in individual Organisation for Economic Co-operation and Development (OECD) countries lacking functional literacy skills range from 7% to 47% (UN Development Program, 2007). In developing countries these figures are far higher. Though there is a range of definitions of functional literacy, most focus on the ability to read basic text and write a simple statement on

Health literacy as a risk factor

The growing awareness of the relationship between literacy and health has led to a range of responses to mitigate the negative effects. This interest is observable in research into the measurement of health-related literacy, examination of the relationship between low literacy and a range of health conditions, and progressive testing of interventions designed to mitigate the effects of low literacy through modified communications, and improved service organization (Coulter and Ellins, 2007,

The measurement of health literacy

The different definitions of health literacy imply that different measurement tools are developed. In the US the TOFLA and REALM measures have been tested, refined and validated over time to provide short screening tools for clinicians to use in everyday practice with a broad range of populations, including, for example, with adolescents (Chisolm & Buchanan, 2007). As indicated above, Baker expresses concern that neither is comprehensive, measuring only selective domains that are thought to be

Where to from here?

The two conceptualizations are similar in some respects but distinctly different in others. Both are dependent on the underlying base of literacy and numeracy, and are context and setting specific. In the asset model, health literacy is a distinct concept, an outcome to health and patient education. In the risk model health literacy is a “prior status” derived from existing literacy and numeracy. In the asset model, health education is directed towards enabling individuals to exert greater

References (28)

  • D.A. DeWalt et al.

    Literacy and health outcomes: a systematic review of the literature

    Journal of General Internal Medicine

    (2004)
  • D.A. DeWalt et al.

    Literacy and its relationship with self-efficacy, trust, and participation in medical decision-making

    American Journal of Health Behavior

    (2007)
  • Educational Testing Service (ETS)

    Test content for health activities literacy tests

    (2006)
  • P. Freebody et al.

    ‘Literacies’ programs: debates and demands in cultural context

    Prospect

    (1990)
  • Cited by (0)

    The following individuals have commented on this paper. Irving Rootman, Kirsten McCaffery, Sian Smith, and Gillian Rowlands.

    View full text