Health literacy as a population-based skill was first introduced four decades ago.
Over the years, the meaning of health literacy has changed from applying reading, writing and numeracy skills in health to a multidimensional concept that includes accessing health information from multiple sources, and understanding and communicating health information.
Although the definition has evolved, the existence of a relationship between health literacy and health outcomes remains unchanged. Generally speaking, people with low health literacy have poorer health outcomes.
As health writers, we need to recognise and understand the social factors that limit health literacy so we can help our readers understand our health information. We can do this by looking at the key outcomes from a range of health literacy research into both local and global communities.
South African researchers investigate health literacy measures
Recent research conducted in South Africa looked at health literacy measures.
While the researchers noted this population group would have marginal or limited health literacy, the team wanted to understand the knowledge levels and competence of individuals within these lower health literacy levels.
The South African researchers took into account local culture, language, socioeconomic environment, literacy and unique disease burden to assess local health literacy skills in Eastern Cape Province.
Study participants were from the small South African town’s local primary healthcare clinic, most who had a chronic health condition and were poorly educated.
Using a literature survey of published health literacy tests, local experts who were familiar with the local healthcare system, created an item bank of knowledge-based and self-reported questions that had relevance to the local population.
The researchers then aligned the questions to 14 scales of health literacy measures, which focused on health literacy strengths and limitations for local individuals and communities, acknowledging the multidimensional nature of health literacy.
What can we learn about health literacy in a South African town?
The researchers grouped the 14 scales of health literacy measures into three domains of health literacy knowledge and cognitive skills:
- Basic understanding of health information and ways to approach a health condition to make informed decisions
- Reading and numeracy skills, including procedural based questions
- Access to information on health services, social support and from healthcare providers, and other resources
As expected, there was a significant increase in individual skills-based health literacy questions as education increased.
However, not a single participant could calculate the 20% chance of getting a cold if four out of 20 people are at risk.
Reading and numeracy skills – interpreting health information
Questions grouped to reading and numeracy skills found only 33 out of the 120 participants had no difficulty understanding written information and only 23 participants needed no help to read instructions, pamphlets and health-related materials.
A third of the 120 participants reported always requiring help when reading general health information.
This finding speaks to the importance of tailoring health information to appropriate reading levels to optimise comprehension.
Although study questions were translated into the local dialect, a small minority may only comprehend English.
As writers we may not have the skills to write in other languages; however, it’s important we ensure our writing is easily translatable.
Literacy is not the sole determinant of health literacy
The study also demonstrated literacy was not the sole determinant of health literacy, particularly in populations with widespread low education.
Questions grouped to access to health information and services found the social environment has a significant influence on health.
Only 20% of participants reported being able to use the internet for health information on the computer and devices.
We also need to consider how we deliver health information to low to middle-income populations.
Using printed pamphlets, patient-provider communication and social support instead of electronic communication can help us effectively deliver health information to low and middle-income countries.
Your take-home message
As health writers, we need to understand local social influences for our target audience to provide context to our writing.
Before writing, it’s important to undertake research that includes understanding language barriers, disease burden and social support in the local population.
- World Health Organization (2009b): The Nairobi Call to Action for Closing the Implementation Gap in Health Promotion. Geneva: WHO.
- Marimwe C. & Dowse R. Development of an item bank of health literacy questions appropriate for limited literacy public sector patients in South Africa Journal of Communication in Healthcare 2017;