Ten things about health literacy
What is health literacy?
To support health literacy, it is important to have a clear understanding of what it is. Health literacy relates to the way we access, understand, appraise, and use health information to achieve our health goals and stay healthy (Turnbull et al., 2022). Health literacy is multi-dimensional with connections across domains of health care, disease prevention and health promotion (Sørensen et al., 2012). Personal and environmental barriers and facilitators can mediate health literacy across the lifespan (Centre for Culture, Ethnicity and Health, 2019). Personal health literacy relates to the knowledge, skills, and motivation of an individual, while organisational health literacy (or health literacy environment) relates to the ways health services can facilitate health literacy. Communication skills and healthcare interactions can have an impact on health literacy, making it important for speech pathologists to understand (Australian Commission on Safety and Quality in Health Care, 2014). The Australian Commission on Safety and Quality in Health Care provide additional information as well as the Australian National statement on health literacy https://www.safetyandquality.gov.au/our-work/patient-and-consumer-centred-care/health-literacy
Access to health information
Being able to find and obtain health information facilitates health literacy. Health information could be written or verbal and in a variety of formats such as brochures, posters, TV ads, YouTube videos, social media posts, or websites. Getting access to health information can be supported by communities and services working towards making information readily available in locations that accessible to everyone. Barriers to accessing health information could include poor or restricted access to the internet, or hinderances in activities such as going to a pharmacy, GP, or speech pathology clinic. A communication disability might mean that a person has trouble knowing what questions to ask in order to get the health information that they need. Facilitating access to appropriate health information might involve providing a handout during a session, pairing written information with our assessments and interventions with clients, or sharing links to good quality online health information.
Understanding health information
Communication and literacy skills can impact the way we understand verbal or written health information and these skills can vary over time and across environments and can be impacted by external factors such as stress and cognitive load (Hunter & Pisoni, 2018). When we are nervous or stressed, we may not be able to understand and retain information to the best of our abilities. Universal concepts such as readability considerations and using plain language can support understanding. We can check readability of written information with tools such as the online Hemingway Editor (https://hemingwayapp.com/), but it is also important to have an individualised approach by finding out what specific supports a person may prefer and benefit from (Anderson et al., 2017).
Appraising the quality of health information
How do we know that health information is appropriate and good quality? Developing the skills to determine whether health information is trustworthy can be challenging. There is also little information about how to support others to appraise health information. The Centre for Disease Control and Prevention (CDC) have supported a website that aims to help families and health professionals to judge the quality of information by asking: Who said it? When did they say it? How did they know? http://www.trustortrash.org/#
Applying (using) health information
It could be easy to assume that once a person has received and understood good quality health information, that they can easily apply it. Supports help a person to be able to put health information to use in their contexts may need to be planned and implemented to maximise opportunities for choice and control in maintaining or improving their health (Horner-Johnson et al., 2011). It may be important to provide supported opportunities for a parent to recall and describe their child’s communication assessment results to a teacher, or it may involve putting images onto a shopping list for independence.
Look for, and reduce barriers
Health professionals have valuable skills and knowledge that can result in individualised intervention and advocacy in collaboration with clients who might be at risk of health literacy difficulties. Speech pathology services can support improvements in comprehension skills, and there are also opportunities to facilitate skills in appraising and applying health information. There is a responsibility to advocate for the communication supports needs that can enable a person to take greater responsibility for their own health information needs. Reducing health literacy barriers might involve reflecting on the availability and accessibility of information available within a health service, as well as reviewing practices around opportunities for clients to participate in the design of services or quality improvement of services.
You don’t need to assess a person’s health literacy to support them
There are valid and reliable tools that have been published for the purposes of assessing health literacy (Boston University, n.d.), however it is not always feasible for clinicians to conduct health literacy assessments and this isn’t necessary before considering how to support health literacy. Understanding what health literacy is and why it is important means that SLPs can make steps to explore the best ways to reduce health literacy barriers and for individuals across environments.
Make written information accessible
When a building is accessible, we might see ramps, wide doorways, rails, and brail signage. For written information we might see images accompanying text, shorter sentences, larger text size, and double-spaced lines. These and other strategies might be applied in documents that might be referred to as ‘Easy Read’, ‘Easy English’, or ‘Aphaisa Friendly’ (For more description see https://www.informationaccessgroup.com/our_services/easy_read.html). There is not yet enough evidence to suggest that simply because a document follows the guides for the above formats that it will be easy to read and understand and research continues to provide insights (Buell et al., 2020; Chinn & Homeyard, 2017). There is some evidence to suggest that it is best to ask a person how best to present information for them, ‘chunk’ information into meaningful components, written in plain language, and accompany written information with opportunity to discuss or provide further explanation and clarification.
Use plain language when you talk and ‘Teach-back’
Use also plain language when we talk can improve understanding (United States Government, 2018). Plain language involve reducing the length of our sentences and use of jargon, but it should not be mistaken for over-simplifying or ‘dumbing-down’ information (Garwood, 2014). The purpose of plain language is for communication to be as clear as possible, but how do we know we have been clear enough? Teach-back is an evidence-based strategy that can be used to check understanding and improve information sharing (see http://teachback.org/ for more information and videos on how to use teach-back).
Support and empower clients
Health professionals can provide support to empower clients, families, and carers to self-advocate and improve their health literacy skills and environments. By demystifying and destigmatising the concept of health literacy, and openly discussing strategies to support health literacy, we can work towards better health outcomes for all (von Wühlisch & Pascoe, 2011).
Anderson, J., McVilly, K., Koritsas, S., Johnson, H., Wiese, M., Stancliffe, R., Lyon, K., Rezzani, N., & Ozge, J. (2017). Accessible written information resources for adults with intellectual disability: A rapid review of the literature. NDS Centre for Applied Disability Research.
Australian Commission on Safety and Quality in Health Care. (2014). National Statement on Health Literacy (p. 4). ACSQHC.
Boston University. (n.d.). Health Literacy Tool Shed: A database of health literacy measures. Retrieved September 28, 2020, from https://healthliteracy.bu.edu/
Buell, S., Langdon, P. E., Pounds, G., & Bunning, K. (2020). An open randomized controlled trial of the effects of linguistic simplification and mediation on the comprehension of “easy read” text by people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 33(2), 219–231. Scopus. https://doi.org/10.1111/jar.12666
Centre for Culture, Ethnicity and Health. (2019, September 10). Health Literacy Primer for Managers and Executives. https://www.healthliteracytraining.com.au/primer/#/lessons/T5q3DF_ghwpW_sYGTj01dl4cH-fac7yV
Chinn, D., & Homeyard, C. (2017). Easy read and accessible information for people with intellectual disabilities: Is it worth it? A meta-narrative literature review. Health Expectations, 20(6), 1189–1200. https://doi.org/10.1111/hex.12520
Garwood, K. C. (2014). Plain, but not Simple: Plain Language Research with Readers, Writers, and Texts. https://uwspace.uwaterloo.ca/handle/10012/8401
Horner-Johnson, W., Drum, C. E., & Abdullah, N. (2011). A randomized trial of a health promotion intervention for adults with disabilities. Disability and Health Journal, 4(4), 254–261. https://doi.org/10.1016/j.dhjo.2011.06.003
Hunter, C. R., & Pisoni, D. B. (2018). Extrinsic Cognitive Load Impairs Spoken Word Recognition in High- and Low-Predictability Sentences. Ear and Hearing, 39(2), 378–389. https://doi.org/10.1097/AUD.0000000000000493
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., Brand, H., & Consortium Health Literacy Project European. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1), 80–93. https://doi.org/10.1186/1471-2458-12-80
Turnbull, H., Dark, L., Carnemolla, P., Skinner, I., & Hemsley, B. (2022). A systematic review of the health literacy of adults with lifelong communication disability: Looking beyond accessing and understanding information. Patient Education and Counseling, S073839912200461X. https://doi.org/10.1016/j.pec.2022.10.008
United States Government. (2018, October 25). What is plain language? https://www.plainlanguage.gov/about/definitions/
von Wühlisch, F. S., & Pascoe, M. (2011). Maximizing health literacy and client recall in a developing context: Speech–language therapist and client perspectives. International Journal of Language & Communication Disorders, 46(5), 592–607. https://doi.org/10.1111/j.1460-6984.2011.00014.x