Skip to main content

The Concept of Health Literacy

  • Chapter
Science | Environment | Health

Abstract

This chapter starts by reviewing narrow and broad definitions of the concept of health literacy and summarizing its various components in a skill attainment model. The model adds to functional health literacy (reading and numeric skills) layers of declarative knowledge (explicit knowledge that can be verbalized), procedural knowledge (knowledge of how to do things), and judgment skills. The use and application of judgment skills is understood as an issue of patient empowerment, but health literacy is not meant to replace the physician’s professional knowledge, skills, and competence. In a second step, ways to measure health literacy are reviewed, including both standard measures of functional health literacy and measures under different labels that may be employed to assess other components of the concept. In a third step, procedural knowledge and judgment skills are looked at from a different angle and identified as an example of Aristotle’s classic concept of practical wisdom. Finally, a case study is added to illustrate the importance of including basic health information in school curricula together with emphasizing the knowledge-based fundamentals of health literacy. It addresses the progressive resistance to antibiotics due to their improper use and finds that basic reading and writing skills are not sufficient to face important challenges in the field of health nowadays, that it cannot be taken for granted that important health issues are covered by media or in medical consultation, and that a judicious use of antibiotics appears to go along not just with the indispensable amount of declarative knowledge but with judgment skills. All of this points to the urgent need to teach health issues such as antibiotics resistance in school, including knowledge of effects and risks as well as judgment skills regarding the proper use of antibiotics

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Anderson, J. R. (2005). Cognitive psychology and its implications. New York: Worth Publishers.

    Google Scholar 

  • Arora, N. K., Ayanian, J. Z., & Guadagnoli, E. (2005). Examining the relationship of patients attitudes and beliefs with their self-reported level of participation in medical decision-making. Medical Care, 43, 865–872.

    Article  Google Scholar 

  • Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs AMA. (1999, Feb 10). Health literacy: Report of the council on scientific affairs. Journal of the American Medical Association, 281(6), 552–557.

    Google Scholar 

  • Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21(8), 878–883.

    Article  Google Scholar 

  • Baker, D. W., Williams, M. V., Parker, R. M., Gazmararian, J. A., & Nurss, J. (1999). Development of a brief test to measure functional health literacy. Patient Education and Counseling, 38(1), 33–42.

    Article  Google Scholar 

  • Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New York, NY: Oxford University Press.

    Google Scholar 

  • Britten, N. (1995). Patients’ demands for prescriptions in primary care. British Medical Journal, 310, 1084–1085.

    Article  Google Scholar 

  • Britten, N. (1997). The influence of patients’ hopes of receiving a prescription on doctors’ perceptions and the decision to prescribe: a questionnaire survey. British Medical Journal, 315, 1506–1510.

    Article  Google Scholar 

  • Brown, S. M., Culver, J. O., Osann, K. E., et al. (2011). Health Literacy, numeracy, and interpretation of graphical breast cancer risk estimates. Patient Education and Counseling, 83(1), 92–98.

    Google Scholar 

  • Butler, C. C., Rollnick, S., Pill, R., Maggs-Rapport, F., & Stott, N. (1998). Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. British Medical Journal, 317, 637–642.

    Article  Google Scholar 

  • Carbon, C., & Bax, R. P. (1998). Regulating the use of antibiotics in the community. British Medical Journal, 317, 663–665.

    Article  Google Scholar 

  • Davis, T. C., Long, S. W., Jackson, R. H., et al. (1993). Rapid estimate of adult literacy in medicine: a shortened screening instrument. Family Medicine, 25(6), 391–395.

    Google Scholar 

  • DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N., & Pignone, M. P. (2004). Literacy and health outcomes: a systematic review of the literature. Journal of General Internal Medicine, 19(12), 1228–1239.

    Article  Google Scholar 

  • Friedman, B.-C., Schwabe-Warf, D., & Goldman, R. (2011). Reducing inappropriate antibiotic use among children with influenza infection. Canadian Family Physician, 57(1), 42–44.

    Google Scholar 

  • Frisch, A., Camerini, L., Diviani, N., Schulz, P. J. (2012). Defining and Measuring Health Literacy: How can we profit from other literacy concepts? Health Promotion International, 27(1), 117–126; doi:10.1093/heapro/dar043

    Google Scholar 

  • Gazmararian, J. A., Baker, D. W., Williams, M. V., et al. (1999). Health literacy among Medicare enrollees in a managed care organization. Journal of the American Medical Association, 281(6), 545–551.

    Article  Google Scholar 

  • Hamm, R. M., Hicks, R. J., & Bemben, D. A. (1996). Antibiotics and respiratory infections: are patients more satisfied when expectations are met? Journal of Family Practice, 43, 56–62.

    Google Scholar 

  • Ishikawa, H., & Yano, E. (2008). Patient health literacy and participation in the health-care process. Health Expectations, 11, 113–122.

    Article  Google Scholar 

  • Kaldjian, L. C. (2010). Teaching practical wisdom in medicine through clinical judgment, goals of care, and ethical reasoning. Journal of Medical Ethics, 36, 558–562.

    Article  Google Scholar 

  • Levy, S. B. (1998). The challenge of antibiotic resistance. Scientific American, 32, 9.

    Google Scholar 

  • Macfarlane, J., Holmes, W., Macfarlane, R., & Britten, N. (1997). Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. British Medical Journal, 315, 1211–1214.

    Article  Google Scholar 

  • Mainous, A. G., Zoorob, R. J., Oler, M. J., & Haynes, D. M. (1997). Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization. Journal of Family Practice, 45, 75–83.

    Google Scholar 

  • Mancuso, J. (2009). Assessment and measurement of health literacy: An integrative review of the literature. Nursing and Health Sciences, 11, 77–89.

    Article  Google Scholar 

  • Mancuso, C. A., & Rincon, M. (2006). Impact of health literacy on longitudinal asthma outcomes. Journal of General Internal Medicine, 21(8), 813–817.

    Article  Google Scholar 

  • Mandler, J. M. (1984). Stories, scripts, and scenes: Aspects of schema theory (Vol. xii, 132 p.). Hillsdale, N.J: L. Erlbaum Associates.

    Google Scholar 

  • Miller, J. D. (1998). The measurement of scientific literacy. Public Understanding of Science, 7, 203–223.

    Article  Google Scholar 

  • Neves, D. M., & Anderson, J. R. (1981). Knowledge compilation: Mechanisms for the automatization of cognitive skills. In J. R. Anderson (Ed.), Cognitive skills and their acquisition (pp. 57–84). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267.

    Article  Google Scholar 

  • Nutbeam, D. (2009). Defining and measuring health literacy: what can we learn from literacy studies? International Journal of Public Health, 54, 303–305.

    Article  Google Scholar 

  • Paasche-Orlow, M. K., Parker, R. M., Gazmararian, J. A., Nielsen-Bohlman, L. T., & Rudd, R. R. (2005). The prevalence of limited health literacy. Journal of General Internal Medicine, 20(2), 175–184.

    Article  Google Scholar 

  • Parker, R. (2000). Health literacy: A challenge for American patients and their health care providers. Health Promotion International, 15(4), 277–283.

    Article  Google Scholar 

  • Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. Journal of General Internal Medicine, 10(10), 537–541.

    Article  Google Scholar 

  • Pattison, R. (1982). On literacy. The politics of the word from homer to the age of rock: Oxford University Press.

    Google Scholar 

  • Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. New York: Oxford University Press.

    Google Scholar 

  • Polanyi, M. (1968). Logic and psychology. American Psychologist, 23(1), 27–43.

    Article  Google Scholar 

  • Powers, B. J., Trinh, J. V., & Bosworth, H. B. (2010, July). Can this patient read and understand written health information? Journal of the American Medical Association, 304(1), 76–83.

    Google Scholar 

  • Rubinelli, S., Schulz, P., & Nakamoto, K. (2009). Letting the patient be a patient. Health literacy beyond knowledge and behavior. International Journal of Public Health, 54(5), 307–311.

    Google Scholar 

  • Ryle, G. (1946). Knowing how and knowing that. Proceedings of the Aristotelian Society, 46, 1–16.

    Article  Google Scholar 

  • Schillinger, D., Grumbach, K., Piette, J., et al. (2002). Association of health literacy with diabetes outcomes. Journal of the American Medical Association, 288(4), 475–482.

    Article  Google Scholar 

  • Schulz, P., & Nakamoto, K. (2005). Emerging themes in health literacy. Studies in Communication Sciences, 5(2), 1–9.

    Google Scholar 

  • Schulz, P. & Nakamoto, K. (2011). “Bad” literacy, the internet, and the limits of patient empowerment. AAAI spring symposium series: Artificial intelligence and health communication. 2011. Stanford, CA, United States.

    Google Scholar 

  • Schulz, P. J., Rubinelli, S., & Hartung, U. (2007). An internet-based approach to enhance self-management of chronic low back pain in the Italian-speaking population of Switzerland: Results from a pilot study. International Journal of Public Health, 52(5), 286–294.

    Article  Google Scholar 

  • Schulz, P. J., Waldburger, B., & Hartung, U. (2005). Towards a judicious use of antibiotics by doctors and patients. Final project report (SNF). HCC Lab Working Paper, No. 2, Lugano.

    Google Scholar 

  • Schwartz, B., & Sharpe, K. (2010). The right way to do the right things. New York: Riverhead Books.

    Google Scholar 

  • Seppala, H., Klaukka, T., Vuopio-Varkila, J., Muotiala, A., Helenius, H., Lager, K., & Huovinen, P. (1997). The effect of changes in the consumption of Macrolide antibiotics on erythromycin resistance in group a streptococci in Finland. The New England Journal of Medicine, 337, 441–446.

    Article  Google Scholar 

  • US Department of Health and Human Services. (2000). Healthy people 2010. With understanding and Improving Health and Objectives for Improving Health. Washington, DC: US Government Printing Office.

    Google Scholar 

  • Wolf, M. S., Gazmararian, J. A., & Baker, D. W. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165(17), 1946–1952.

    Article  Google Scholar 

  • World Health Organization. (1998). Divisions of health promotion, education and communications health education and health promotion unit. Health Promotion Glossary. Geneva: World Health Organization.

    Google Scholar 

  • Zarcadoolas, C., Pleasant, A. F., & Greer, D. S. (2006). Advancing health literacy. A framework for understanding and action. San Francisco: Jossey Bass.

    Google Scholar 

Download references

Acknowledgments

Practical wisdom has been recently linked to clinical judgments by Kaldjian (2010). This has inspired our line of reasoning. Also, some contemporary bioethicists discussed the importance of Aristotle’s and Aquinas’ concept of virtue to the practical wisdom of physicians (Pellegrino and Thomasma 1993; Beauchamp and Childress 2009). For a comprehensive treatment of the role of practical wisdom in everyday life, see Schwartz and Sharpe (2010).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter J. Schulz .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media B.V.

About this chapter

Cite this chapter

Schulz, P.J. (2012). The Concept of Health Literacy. In: Zeyer, A., Kyburz-Graber, R. (eds) Science | Environment | Health. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-3949-1_5

Download citation

Publish with us

Policies and ethics