The young and multidisciplinary field of health literacy emerged from two expert groups; physicians and other health providers and health educators, and Adult Basic Education (ABE) and English as Second Language (ESL) practitioners. Physicians are a source of groundbreaking patient comprehension and compliance studies. Adult Basic Education / English for Speakers of Languages Other Than English (ABE/ESOL) specialists study and design interventions to help people develop reading, writing, and conversation skills and increasingly infuse curricula with health information to promote better health literacy. A range of approaches to adult education brings health literacy skills to people in traditional classroom settings, as well as where they work and live. (See the links at WorldEd http://www.worlded.org/us/health/lincs, and “A Selection of Health Literacy Articles and Research” published by Partnership for Clear Health Communication: http://www.askme3.org/pdfs/bibliography.pdf.)
The biomedical and psychological approach to health literacy dominant in the 1980s and 1990s often depicted individuals as lacking, or “suffering” from, low health literacy, assumed that recipients are passive in their possession and reception of health literacy, and believed that models of literacy and health literacy are politically neutral and universally applicable. This approach is found lacking when placed in the context of broader ecological approaches to health.
A more robust view of health literacy includes the ability to understand scientific concepts, content, and health research; skills in spoken, written, and online communication; critical interpretation of mass media messages; navigating complex systems of health care and governance; and knowledge and use of community capital and resources, as well as using cultural and indigenous knowledge in health decision making (Nutbeam, 2000; Ratzan, 2001; Zarcadoolas, Pleasant, & Greer, 2002).
This perspective defines health literacy as the wide range of skills, and competencies that people develop over their lifetimes to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks, and increase quality of life (Zarcadoolas, Pleasant, & Greer, 2006).
Defining health literacy in that manner builds the foundation for a multi-dimensional model of health literacy built around four central domains:
civic literacy, and
Skills in one domain can contribute to developing literacy skill in another domain, and competencies in one area can compensate for a lack of competencies in another.
Finally, it must be stressed that health literacy skills are not only a problem of the public. Health care professionals (doctors, nurses, public health professionals) can also have poor health literacy skills; most often captured by a reduced ability to clearly explain health issues to patients and the public.
Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267.
Ratzan, S. C. (2001). Health literacy: Communication for the public good. Health Promotion International, 16(2), 207–214.
Zarcadoolas, C., Pleasant, A., & Greer, D. (2005, June). Understanding health literacy: An expanded model. Health Promotion International, 20, 195–203.
Zarcadoolas, C., Pleasant, A., & Greer, D. (2006). Advancing health literacy: A framework for understanding and action. Jossey-Bass: San Francisco, CA.