Health Literacy

Overview

Health Literacy is the ability to absorb and use information relating to health. Low levels of health literacy are associated with higher levels of hospital admissions, emergency department attendances and reduced up-take of screening and vaccinations. Additionally, low health literacy is linked to poorer general health and increased mortality.

History

The concept of health literacy evolved from a history of defining, redefining, and quantifying the functional literacy needs of the adult population. Along with these changes has come the recognition that sophisticated literacy skills are increasingly needed to function in society and that low literacy may have an effect on health and health care. In 2006, David Baker offered a perspective about the meaning and the measure of health literacy. He astutely acknowledged that there was a lack of shared meaning of the term “health literacy,” noting, “Ironically, as the field of health literacy has expanded in scope and depth, the term ‘health literacy’ itself has come to mean different things to various audiences and has become a source of confusion and debate”

Health Literacy Skills

There are varying definitions of the basic skills that comprise health literacy. One of the more comprehensive lists is provided by the Institute of Medicine, and is as follows:

• "promote and protect health and prevent disease"
• "understand, interpret, and analyze health information"
• "apply health information to a variety of life events and situations"
• "navigate the health care system"
• "actively participate in encounters with health care providers"
• "understand and give consent"
• "understand and advocate for rights"

Cultural/Social Contexts of Health Literacy

It is important to note that a patient's cultural, social-political, religious, and/or ethnic background will affect how they conceive of health.. This can create issues for those immigrating to a country with an unfamiliar social, political, and/or cultural structure, as well as additional issues associated with language barriers.

Anne Fadiman's non-fiction book, The Spirit Catches You And You Fall Down, examines the case of Lia Lee, the daughter of Hmong parents who immigrated to the USA. Lia suffered from severe health issues, and Fadiman documents the difficulties brought about by clashing cultural norms and language barriers between Lee's parents and the US hospital system.

Social Construction of Health Literacy

Freidson (1970) addressed "how signs and symptoms get to be labeled or diagnosed as an illness in the first place. Foucault regarded knowledge as a form of power., and he stresses how medical discourse constructs knowledge about the body, including disease. In turn, medical discourse can influence people's behaviors, impact their subjective experiences to shape their identities, and to legitimate medical interventions. Accordingly, one's medical knowledge reveals his or her embedded beliefs, normalizing tendencies, and relationship to embodiment and self-identity. Overall, illness experience and health literacy (how we view or believe them or be "illnesses") are shaped by social interactions, shared cultural traditions.

In this regard, all illnesses are not the same. Some illnesses are stigmatized, and other are not; some are contested, and others are not; some are considered disabilities, while others are not. What is important about these distinctions is that they exist for social rather than purely biological reasons. These cultural meanings have an impact on the way the illness is experienced, how the illness is depicted, the social response to the illness, and what policies are created concerning the illness.

Social Construction of Medicalization

Medicalization occurs when human problems or experience become defined as medical problems. Particular diagnosis is developed and becomes accepted as medically valid, and gets used to define/treat patients. However, there is increasing evidence that commercial aspects of medicine (ex. pharmaceutical industry), and they “shape” medical knowledge to promote their products, which can be highly misleading.

• Placebo Effect: Placebo is anything that seems to be a "real" medical treatment, but isn't. It is a "fake" treatment. Depending on the situation, some people can have a response to a placebo. Their symptoms may improve or may have what appears to be 'side effect' from the treatment. These responses are known as "placebo effect". Our belief and expectations are "manipulated"; we believe that the pills will make us or help us to improve. Research shows that placebo effect is largely focused on the notion of "relation of mind and body". If a person expects a pill to do something to their body, then it is possible that the body's own chemistry can cause effects similar to what a "medication" might have caused.

Consequences

Low health literacy has clear connection with health and well-being of individuals, families, and communities, as they have difficulty with completing functional tasks (such as filling out patient registration forms). It creates communication difficulties with different racial or ethnic or linguistic backgrounds. Patients' cultural beliefs about disease, prevention, and treatment can lead to misunderstandings, resulting in distrust of medical personnel, worsening health conditions, and even death.

Some definitions characterize health literacy as a product of both an individual's capabilities and the demands of the health care system. At issue is whether individuals' level of health literacy would be considered higher or lower based on variation in the complexity of the information they encounter. One could argue that the population's health literacy would be higher if health-related materials and communication more universally integrated principals of clear language, making them easier to understand and a closer match to individuals' skill level. Definitions of health literacy have begun to embrace a more ecologically framed conceptual model with an appreciation for the role of language, culture, and social capitol. This more robust perspective should also recognize the role that health information technology is beginning to play in society and the need for considering the ability to use this technology as a component of health literacy skills. Technology will continue to impact both our understanding and measurement of literacy and health literacy, as it increasingly becomes an accepted mode for communicating health information. We agree that an ecologically framed perspective is appropriate and useful; however, we believe that caution is warranted to ensure that the conceptualization of health literacy does not become immeasurable and blur with other concepts, such as patient-centered communication.