The Concept of Health Literacy

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

References

  1. Anderson, J. R. (2005). Cognitive psychology and its implications. New York: Worth Publishers.Google Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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
  4. Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21(8), 878–883.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New York, NY: Oxford University Press.Google Scholar
  7. Britten, N. (1995). Patients’ demands for prescriptions in primary care. British Medical Journal, 310, 1084–1085.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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
  10. 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.CrossRefGoogle Scholar
  11. Carbon, C., & Bax, R. P. (1998). Regulating the use of antibiotics in the community. British Medical Journal, 317, 663–665.CrossRefGoogle Scholar
  12. 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
  13. 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.CrossRefGoogle Scholar
  14. 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
  15. 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/dar043Google Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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
  18. Ishikawa, H., & Yano, E. (2008). Patient health literacy and participation in the health-care process. Health Expectations, 11, 113–122.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. Levy, S. B. (1998). The challenge of antibiotic resistance. Scientific American, 32, 9.Google Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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
  23. Mancuso, J. (2009). Assessment and measurement of health literacy: An integrative review of the literature. Nursing and Health Sciences, 11, 77–89.CrossRefGoogle Scholar
  24. Mancuso, C. A., & Rincon, M. (2006). Impact of health literacy on longitudinal asthma outcomes. Journal of General Internal Medicine, 21(8), 813–817.CrossRefGoogle Scholar
  25. Mandler, J. M. (1984). Stories, scripts, and scenes: Aspects of schema theory (Vol. xii, 132 p.). Hillsdale, N.J: L. Erlbaum Associates.Google Scholar
  26. Miller, J. D. (1998). The measurement of scientific literacy. Public Understanding of Science, 7, 203–223.CrossRefGoogle Scholar
  27. 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
  28. 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.CrossRefGoogle Scholar
  29. Nutbeam, D. (2009). Defining and measuring health literacy: what can we learn from literacy studies? International Journal of Public Health, 54, 303–305.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. Parker, R. (2000). Health literacy: A challenge for American patients and their health care providers. Health Promotion International, 15(4), 277–283.CrossRefGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. Pattison, R. (1982). On literacy. The politics of the word from homer to the age of rock: Oxford University Press.Google Scholar
  34. Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. New York: Oxford University Press.Google Scholar
  35. Polanyi, M. (1968). Logic and psychology. American Psychologist, 23(1), 27–43.CrossRefGoogle Scholar
  36. 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
  37. 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.CrossRefGoogle Scholar
  38. Ryle, G. (1946). Knowing how and knowing that. Proceedings of the Aristotelian Society, 46, 1–16.Google Scholar
  39. 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.CrossRefGoogle Scholar
  40. Schulz, P., & Nakamoto, K. (2005). Emerging themes in health literacy. Studies in Communication Sciences, 5(2), 1–9.Google Scholar
  41. 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
  42. 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.CrossRefGoogle Scholar
  43. 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
  44. Schwartz, B., & Sharpe, K. (2010). The right way to do the right things. New York: Riverhead Books.Google Scholar
  45. 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.CrossRefGoogle Scholar
  46. 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
  47. 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.CrossRefGoogle Scholar
  48. 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
  49. Zarcadoolas, C., Pleasant, A. F., & Greer, D. S. (2006). Advancing health literacy. A framework for understanding and action. San Francisco: Jossey Bass.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Università della Svizzera italianaLuganoSwitzerland
  2. 2.Virginia TechBlacksburgUSA

Personalised recommendations