EPALE's Thematic Coordinator David Mallows reflects on how health literacy can be used as a tool to help people to take a more assertive and more active role in their own healthcare.

Low health literacy and poor health

In a previous blog post for EPALE I discussed what we mean by ‘health literacy’. I used the US Health Department definition of health literacy:

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

This definition suggests that poor literacy is a potential health risk factor, and measures need to be taken to improve the individual’s literacy so he/she can better make sense of and follow medical advice. Indeed, low literacy is connected directly and indirectly to a wide range of poor health outcomes. Bad individual health management (overeating, drinking too much alcohol, smoking, lack of exercise, ignoring symptoms) are often associated with a lack of understanding of health advice from public health information campaigns or medical professionals. Poor health literacy has been shown to affect individuals’ ability to correctly follow prescription instructions for medications, and their capacity to self-manage illnesses. It would appear then that improving individual levels of literacy in society would produce substantial public health benefits.

However, health literacy is not just an individual issue. The effects of poor literacy can also be mitigated by improving the quality of public communication about health, and increasing health professionals’ sensitivity of the potential impact of poor literacy on understanding of health issues. Growing awareness of the relationship between literacy and health information has led to changes to traditional health education in printed and online communications, as well as greater focus on effective oral communication between health professionals and members of the public.

Health literacy is multilevelled

The US Health Department definition conceptualises literacy as a set of capacities, with the implication that health literacy is knowledge-based and so there are things that we need to know and these can be taught through public education programmes. It also accepts that health literacy is context-dependent and thus influenced by the ways in which health care services are packaged and delivered. Thus, any health literacy initiative should focus on developing context-specific health knowledge, and the confidence necessary to use that to better control health and health-related decision making.

Health literacy models have generally accepted the following three ‘levels’ of health literacy: functional, interactive and critical.

Functional health literacy concerns the communication of factual information about health risks and effective use of the health system; it focuses on individuals’ knowledge of health risks and health services, and compliance with prescribed actions. Interactive health literacy is focused on the development of personal skills in a supportive environment with the aim of improving individuals’ motivation and self-confidence to act independently on medical advice received. Critical health literacy goes a stage further and enables individuals to understand and act upon the social and economic determinants of health.

Health literacy as an empowerment tool

As an alternative to the definition given by the US Health Department, the World Health Organisation guidelines position health literacy in relation to the promotion of good health:

‘Health literacy represents 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. Health literacy implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions.’

This introduces a new idea, that by improving their health literacy, not only will people be better able to read the information leaflet they are given by their doctor, or take their medication as prescribed, they will be also empowered to take a more assertive and more active role in their own healthcare. This acknowledges a critical component of health literacy and aims at empowerment rather than compliance of individuals with the implication that progressively greater autonomy in decision making is key to addressing individual and social determinants of poor health.

Conceptualising health literacy in this way implies that one goal of adult education should be empowerment through the development of health literacy skills. Health literacy skills should be more than functional, they should also allow for interactive and critical engagement with personal health. Adult health education should improve participants’ knowledge, understanding and capacity to act; it should not be limited to achieving changes in individuals’ lifestyles or enhancing their ability to follow prescribed treatments. Such adult education initiatives should also raise awareness of the socioeconomic reality that has led to the current state of the nation’s health and promote actions that may lead to improvement in the health and wellbeing of individuals and the societies in which they live.

David Mallows has 30 years of experience in adult education as a teacher, teacher trainer, manager and researcher. He was previously Director of Research at the National Research and Development Centre for adult literacy and numeracy (NRDC) at the UCL Institute of Education, London and currently represents the European Basic Skills Network in EPALE as thematic coordinator for Life Skills.