Health literacy is defined as “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Healthy People, 2010 cited in Paasche-Orlow et al., 2005, p. 175). The word Health literacy was first appeared in 1974 in a paper which calls for “education standards for all grade school levels in USA” (Peerson and Saunders, 2009, p. 285). Health literacy not only addresses the literacy aspects of an individual, it is also linked with the overall health status of an individual, in the recent decades researchers identified the relation between health literacy and the health outcome (Speros, 2005). According to an estimation, around ninety million people in USA have poor literacy and have problems in understanding health related information (Hawkins, Kantayya and Sharkey-Asner, 2010). Health literacy is a newly emerged concept in health promotion research and some recent works suggest that there is a relation between literacy, low health and premature deaths (Zarcadoolas, Pleasant and Greer, 2005). This essay will explore these issues. It will begin by considering awareness of health literacy, it will then discuss on the influence of health literacy on the health.
Literacy and health
Low literacy is common among the people all over the world, even developed countries have low literacy levels and in developing countries these figure are much higher (Nutbeam, 2006). (Hemming and Langille, 2006) stated that literacy is the essential basic for health literacy and individual’s life reflects the relationship with health and literacy. Education plays a key role in addressing the health of an individual, improving the literacy among the people will tackle one of the major inequalities of health because it indirectly indicates an individual’s capacity to make healthy choices (Nutbeam and Kickbusch, 2000). Literacy have more influence on health than all other demographic variables and other factors like age, ethnicity and race (Manganello, 2008). People with low literacy may have difficulties in understanding the information related to health matters like medical prescriptions, instructions and recommendations by their health care provider (Hahn and Cella, 2003). Ivnik and Jett (2008) also explains that the discriminations in individuals ability to read and to interpret the information available related to personal care and health care services also contribute to the disparities of health. In an study by (Dewalt et al., 2004) found that people with poor literacy are misusing the preventive measures like taking the vaccinations and they are never gone to take the screening tests like cancer smear tests and mammography. According to an estimation in United States of America about 75 percent of people with chronic diseases are having limited literacy levels (Ivnik and Jett, 2008).
Awareness on Health literacy
The concept of health literacy was first originated in early years and it was recognised as an autonomous research field in 1990s (Pleasant and Kuruvilla, 2008). Mika et al. (2005) suggests that finding more information on health literacy and the problems associated with it in population with health disparities is very important. But proper preference is not given to the health literacy which is a key problem which acts as a barrier between the health care systems and people seeking health services (Speros, 2005). Moreover Zahnd, Scaife and Francis (2009) explains that health literacy is focused on three domains they are, clinical understanding which is the ability to understand the directions on the prescriptions, prevention by recognising the signs and symptoms of a disease and using health care systems by understanding the services provided by it. The awareness on the health and the literacy is increasing, and several governments are implementing various national programmes to raise literacy levels and health standards. Some organisations are implementing health awareness programmes in the community, and they promote them through media, social marketing and printed materials. However, people who can read pamphlets and printed text can only know the information in it. So accessibility to health information is a key factor among every individual in community, which can be achieved by health literacy(Hemming and Langille, 2006). Moreover ishikawa and Yano (2008) explains that the studies on health literacy up to present are only concentrated on the communication between individual seeking health care and health care providers in an medical setting, it might be expanded to address the more broader aspects of health literacy in population rather than individual level.
Estimation of Health literacy and its outcome
As the awareness on the health literacy is rapidly growing various assessment scales are developed to estimate the impact of health literacy on health outcomes. Currently ‘Rapid Estimate of Adult Literacy in Medicine’ (REALM) and the ‘Test of Functional Literacy in Adults’ (TOFHLA) is the widely used scales in clinical setting to measure the reading ability of patients (Hixon, 2004). Nutbeam (2009) also argues that these tools only measure the selective knowledge of overall capacity of an individual but not in particular aspects of health literacy. In addition Pleasant and Kuruvilla (2008), argue that none of these make sense of an appropriate measurement of health literacy. There is a continuing debate on what should be measured health literacy in an individual perspective or a relation between health systems and individual skills (Jordan, Buchbinder and Osborne, 2010). The Test of Functional literacy in adults measures the adult literacy rates in health care field and only concentrates on individual capacity to read the medical information on some medical slips and labels, Rapid Estimate of adult literacy is a short screening tool made to measure adult literacy in medical settings but no tool is made till now to access the broader aspects of health literacy (Mika et al., 2005). Baker (2006) claims that it is important to show a difference between general literacy and reading ability of health material, because the capacity to perceive the health information is more likely related to health outcomes than general reading ability. United States of America developed a national assessment scale called National Adult Literacy Scale to measure the health literacy among the adults, this scale consists of twenty six health related questions in it to access the prevalence of health literacy (Hawkins, Kantayya and Sharkey-Asner, 2010). According to the reports by NALS in the year 1993 about fifty million of population in America are having inadequate health literacy (Speros, 2005).
All these screening tools only measure the reading abilities of an individual in health field they failed to access the other forms of information seeking and health knowledge gained through the oral communications (Nutbeam, 2008). literacy means not only the ability to read the text it is the capacity to understand and use the text or information available in the form of passages, figures or any other forms (Zahnd, Scaife and Francis, 2009).
Health Literacy and its impact on individual health
The researchers recently came to know the problems associated with the health literacy, they came to know the role played by it in the medical as well as the individual self care by the comprehension of information related to health and the outcomes related to it (Speros, 2005).The people with poor literacy levels may be prone to have bad health status and show more unhealthy behaviours like excessive alcohol intake and smoking (San Diego, Calif 2004).The People having low health literacy may possess weak communication skills on health related issues may lead to improper diagnosis of their health condition and inappropriate usage of medication and using of health care services. Nutbeam (2008) have proposed three critical points where the health literacy shows its impact on community, they are as follows reaching to the health care services, Communication between the health care staff and patients, and personal care. Paasche-Orlow and Wolf (2007) claims that, distinguishing the independent effects of health literacy is quite difficult due to the complex issues like demographic variables and social determinants are interrelated to it.
The people with low health knowledge may be more likely to lead an unhealthy lifestyle due to the lack of minimum health consciousness on the prevention of several infectious diseases, proper using of the vaccinations and poor management of various illnesses, and there is a more chance of acquiring diseases because health outcome often depends on self management of the patient (Gazmararian et al., 2005). The people with low literacy skills are spending four times more expenditure on their health care, according to some estimates in United States more than 75% of people having chronic mental or physical illness comes under poor literacy category (Ivnik and Jett, 2008). A person with the ability to read and understand the basic level health issues have the capacity to make use of health care services, and they can manage their health by lifestyle modification and by increasing their living standards at an individual and community level (Nutbeam, 2008). Health literacy improves the public to access available information of health and the ability to give appropriate feedback on his own health status, decision making on health and can lead a disease free lifestyle which lessens the frequent visits to hospitals (Speros, 2005).
Different ways to promote Health Literacy
Various awareness programmes conducted by government such as national eradication programmes in prevention of Poliomyelitis, Malaria, Tuberculosis, etc., and some awareness programmes on maternal health, paediatric health, etc. are promoting health literacy by educating the people on diseases and its preventive method. Health literacy may be promoted through visual media, printed material, and internet sources (Bastian, 2008). However, these sources sometimes don’t show satisfactory outcomes. The people who are illiterates are misusing the services available because they cannot understand the basic printed information available and complex issues like using internet sources is quite complicated to those people. Health information is more complex these days the information can only be understood by experts (Gazmararian et al., 2005). Patients with less minimum health literacy may feel shame to communicate with their health care providers and they feel shy in asking help from their physician and leave with incomplete information and they may not know how to use the medications and when is their next appointment for their follow up of health condition and they just ignore their medical care (Hahn and Cella, 2003). Safeer and Keenan (2005) suggest that the information provided by the physicians to the patients should be in a simple manner so that the condition and the medical treatment should be clearly understood by the patient. Alternatively Egbert and Nanna (2009), suggests that the health information should be made in a user friendly manner which is in an easily accessible manner which explicit information with visual links(Ivnik and Jett, 2008). The best way to promote health literacy is through the direct interaction by health care providers with the people who cannot read (Shaw et al., 2009). Tanya and Al-Assaf (2006) suggests that, Nurses and other health care persons should act as Health volunteers and create a convenient environment so that the people can interact with health educators and discuss on health issues, efforts are made to increase patient and physician interaction . In addition it is advised to the patients to develop the communication with their physician and health care providers regarding their health status, treatment procedures, follow up and effective self care for a healthy life style (Mika et al., 2005).
This essay had considered a range of issues to do with health literacy including an estimation of the extent of the problem and strategies to address the issue. Health literacy plays a key role on the overall health and wellbeing. Multiple factors like proper usage of health care services, communication of health issues with health care providers, leading healthy lifestyle, good hygienic conditions, taking preventive measures like immunisation, which might show to impact an individual’s physical and mental wellbeing are directly or indirectly associated with health literacy. So it is suggested that promoting health literacy will make a healthy community, and it should be considered as a primary public health goal.