This literature review was prepared by Workbase for the Health Quality & Safety Commission. It provides guidance for the development of the training tools and resources that have been prepared for the Health Literacy Medication Safety demonstration project.
This project aims to provide key pharmacy staff with information and tools to increase their understanding of health literacy, adult learning theory and communication skills.
As the sphere of health continues to grow and become more complex, the relationship between the health system, health professionals and the health consumer also continues to change and evolve. Health literacy is a concept that lies at the centre of this evolving relationship.
While health literacy is a relatively new field, particularly in New Zealand, definitions of health literacy have been informed by the Organisation for Economic Co-operation and Development (OECD) surveys of literacy amongst individuals and societies (Ministry of Education 2008). ‘Health literacy’ and ‘literacy’ are relative terms in that the health literacy (knowledge and skills) required in a given situation is determined by the health literacy demands created by the situation. These demands include immediate literacy skill demands, such as reading health materials or speaking with a health professional, and health knowledge demands, such as understanding how the body works or disease theory. These demands also include systemic factors and influences, such as the time a health professional has to spend with a patient, and how complex it is to access health services and support. Health literacy is also affected by the unfamiliarity of information and concepts, and the stress or anxiety experienced by patients and families in health situations.
Health literacy involves more than using literacy skills in a health context. Literacy and numeracy skills and knowledge, such as reading, writing, speaking, listening and numeracy, are central to health literacy. The term also encompasses skills and knowledge unique to health, such as a conceptual understanding of how the body works, knowing when and where to seek health advice, being able to evaluate the appropriateness of health advice, being able to interpret and describe health symptoms, as well as acting with confidence in a health setting (Institute of Medicine 2004; Zarcadoolas et al 2006; Rudd et al 2007).
There is a variety of definitions of health literacy that generally fall within two categories: health literacy as a set of individual capacities that allow a patient to successfully navigate a health care environment; or health literacy as an interaction between individual capacities of patients, families and health professionals and the health care environment in which they operate (Nutbeam 2008; Rudd et al 2007; Institute of Medicine 2004; Kickbusch et al 2005). How health literacy is defined affects the way in which improvements in health literacy are sought and how (or whether) health literacy is measured (Nutbeam 2008; Baker 2006).