The term literacy has found itself attached to many different concepts in the last decade or so – computer literacy, cultural literacy, digital literacy, media literacy, visual literacy, to name a few. Literacy, of course, is the term that is most familiar in all of these combinations, and its meaning is not unfamiliar. Literacy is the basic ability to read, comprehend, and write. So, what new dimensions does the concept literacy take on when attached to these other concepts? In particular, what does it mean for a person to be health literate? What is health literacy?
Whereas literacy focuses on an individual’s ability to read and write, health literacy – as defined by the U.S. Department of Health and Human Services (2010) – is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Hagell, Rigby, and Perrow (2015) cite the following definition: “the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the health-care, disease prevention and health promotion setting” (p. 82). It varies from “plain old” literacy in that one can be literate and not be health literate, though one cannot be health literate without being literate, since the ability to access, understand, appraise, and apply health-related information are all dependent on an individual’s ability to read and write. For example, a person may be able to read the directions given to him when he receives a prescription from the pharmacy. The label may say “take PRN,” and the patient understands the word “take” but if he is not health literate, he will not know that PRN stands for pro re nata – the Latin for “take as needed.” While the individual can read the words, he does not understand their meaning in the context of health care. However, a health literate person may know this from previous experience or may have the presence of mind to ask the prescription professional or pharmacist what that means. Such a question reflects a proactive attitude towards health literacy, and obtaining the answer and remembering it in the future reflects a gain in the individual’s level of literacy.
Unfortunately, just as there are people who are not literate, there are people who are not health literate. This is problematic because it “may restrict the patient’s ability to be an active participant in medical consultations because of limited familiarity with health-related terms” (Glanz, Rimer, & Viswanath, 2008, p. 257). Furthermore, a lack of literacy is probably the result of poor educational attainment, which has been connected to unhealthy behaviors (Resnick & Siegel, 2013). A consequence of poor health literacy is the failure to appreciate the long-term consequences of one’s health choices. Another is not being aware of services, support, and resources that may help an individual make better choices or change bad habits, such as smoking cessation (Stewart, Adams, Cano, Correa-Fernández, Li, Waters, & … Vidrine, 2013). A lack of such awareness of – or the ability to access such resources – can lead to cascading health problems and/or comorbidities which could be easily prevented.
One population at risk for potential health problems due to low health literacy levels are individuals in rural, low-income areas. These areas are often also plagued by low literacy or education attainment, a circumstance which has already been identified as being related to poor health outcomes (Resnick & Siegel, 2013). Not only are these individuals at risk because of their low literacy or educational levels, they are often also at risk as a result of socio-economic factors. A 2011 study of the lower Mississippi Delta region found that health literacy levels could predict certain health behaviors – in this case, the consumption of sugar-sweetened beverages (SSB) like sweet tea or soda (Zoellner et al., 2011). The participants did not apparently understand the health outcomes (such as diabetes) associated with excessive SSB consumption, a fact reflected in their health literacy level scores.
- Glanz, K., Rimer, B. R., & Viswanath, K. (2008). Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA: Josey-Bass.
- Hagell, A., Rigby, E., & Perrow, F. (2015). Promoting health literacy in secondary schools: A review. British Journal of School Nursing, 10(2), 82-87.
- Resnick, E. A., & Siegel, M. (2013). Marketing public health: Strategies to promote social change (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
- Stewart, D. W., Adams, C. E., Cano, M. A., Correa-Fernández, V., Li, Y., Waters, A. J., & … Vidrine, J. I. (2013). Associations between health literacy and established predictors of smoking cessation. American Journal of Public Health, 103(7), e43-e49. doi:10.2105/AJPH.2012.301062
- U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved from http://health.gov/communication/HLActionPlan/
- Zoellner, J., You, W., Connell, C., Smith-Ray, R. L., Allen, K., Tucker, K. L., … & Estabrooks, P. (2011). Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: Findings from the rural Lower Mississippi Delta. Journal of the American Dietetic Association, 111(7), 1012-1020.