Health literacy assessment in the clinic: benefits, pitfalls and practicalities
Claire M. Ellender
A B * , Mary Boyde C D and Ian A. Scott B E
+ Author Affiliations
- Author Affiliations
A Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, Qld 4102, Australia.
B Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.
C Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia.
D School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Qld, Australia.
E Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, Qld, Australia.
* Correspondence to: Claire.ellender@health.qld.gov.au
Australian Journal of Primary Health 28(5) 365-370 https://doi.org/10.1071/PY22015
Submitted: 1 February 2022 Accepted: 5 March 2022 Published: 26 May 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University.
Abstract
Approximately 60% of Australians have low or marginal health literacy, which is associated with poorer outcomes in patients with chronic disease. Patient-centred strategies (such as reduced medical jargon, use of pictograms, multimedia narratives) are effective in improving outcomes for many chronic diseases, with the impact being greatest in individuals with low health literacy. However, clinicians need a reliable and practical tool for assessing health literacy, the results of which help inform the choice of communication techniques best tailored to deliver information to patients. This article reviews the evidence of health literacy as an independent predictor of poor disease outcomes, describes feasible methods for assessing health literacy and presents communication strategies aimed at facilitating shared decision-making among those with low health literacy.
Keywords: health literacy, low literacy, questionnaires, screening.
References
Arozullah AM, Yarnold PR, Bennett CL, Soltysik RC, Wolf MS, Ferreira RM, Lee S-YD, Costello S, Shakir A, Denwood C, Bryant FB, Davis T (2007) Development and validation of a short-form, rapid estimate of adult literacy in medicine. Medical Care 45, 1026–1033.| Development and validation of a short-form, rapid estimate of adult literacy in medicine.Crossref | GoogleScholarGoogle Scholar | 18049342PubMed |
Australian Bureau of Statistics (2018) ‘National Health Survey: first results, 2017–2018.’ (ABS: Canberra) Available at https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release#data-download
Australian Commission on Safety and Quality in Health Care (ACSQHC) (2014a) Health Literacy National Statement. (ACSQHC: Sydney, NSW, Australia) Available at https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-statement-health-literacy-taking-action-improve-safety-and-quality
Australian Commission on Safety and Quality in Health Care (ACSQHC) (2014b) ‘Health literacy: Taking action to improve safety and quality.’ (ACSQHC: Sydney, NSW, Australia) Available at https://www.safetyandquality.gov.au/wp-content/uploads/2014/08/Health-Literacy-Taking-action-to-improve-safety-and-quality.pdf
Ayre J, Bonner C, Cvejic E, McCaffery K (2019) Randomized trial of planning tools to reduce unhealthy snacking: implications for health literacy. PLoS One 14, e0209863
| Randomized trial of planning tools to reduce unhealthy snacking: implications for health literacy.Crossref | GoogleScholarGoogle Scholar | 30653531PubMed |
Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J (1999) Development of a brief test to measure functional health literacy. Patient Education and Counseling 38, 33–42.
| Development of a brief test to measure functional health literacy.Crossref | GoogleScholarGoogle Scholar | 14528569PubMed |
Bann CM, McCormack LA, Berkman ND, Squiers LB (2012) The Health Literacy Skills Instrument: A 10-Item Short Form. Journal of Health Communication 17, 191–202.
| The Health Literacy Skills Instrument: A 10-Item Short Form.Crossref | GoogleScholarGoogle Scholar | 23030570PubMed |
Batterham RW, Hawkins M, Collins PA, Buchbinder R, Osborne RH (2016) Health literacy: applying current concepts to improve health services and reduce health inequalities. Public Health 132, 3–12.
| Health literacy: applying current concepts to improve health services and reduce health inequalities.Crossref | GoogleScholarGoogle Scholar | 26872738PubMed |
Brach C (2017) The Journey to Become a Health Literate Organization: A Snapshot of Health System Improvement. Studies in Health Technology and Informatics 240, 203–237.
Brega AG, Barnard J, Mabachi NM, Weiss BD, DeWalt DA, Brach C, Cifuentes M, Albright K, West DR (2015) ‘AHRQ Health Literacy Universal Precautions Toolkit’, 2nd edn. (University of Colorado: Rockville, MD)
Bush, R, Boyle, F, Ostini, R, Ozolins, I, Brabant, M, Jimenez Soto, E, Eriksson, L (2010) Advancing health literacy through primary health care systems. Australian Primary Health Care Research Institute, Canberra, ACT, Australia.
Chew LD, Bradley KA, Boyko EJ (2004) Brief questions to identify patients with inadequate health literacy. Family Medicine 36, 588–594.
Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, Crouch MA (1993) Rapid estimate of adult literacy in medicine: a shortened screening instrument. Family Medicine 25, 391–395.
Fabbri M, Murad MH, Wennberg AM, Turcano P, Erwin PJ, Alahdab F, Berti A, Manemann SM, Yost KJ, Finney Rutten LJ, Roger VL (2020) Health literacy and outcomes among patients with heart failure: a systematic review and meta-analysis. JACC: Heart Failure 8, 451–460.
| Health literacy and outcomes among patients with heart failure: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 32466837PubMed |
Hackney JE, Weaver TE, Pack AI (2008) Health literacy and sleep disorders: a review. Sleep Medicine Reviews 12, 143–151.
| Health literacy and sleep disorders: a review.Crossref | GoogleScholarGoogle Scholar | 18222098PubMed |
Housten AJ, Lowenstein LM, Hoover DS, Leal VB, Kamath GR, Volk RJ (2018) Limitations of the S-TOFHLA in measuring poor numeracy: a cross-sectional study. BMC Public Health 18, 405
| Limitations of the S-TOFHLA in measuring poor numeracy: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar | 29587709PubMed |
Kalichman SC, Ramachandran B, Catz S (1999) Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of General Internal Medicine 14, 267–273.
| Adherence to combination antiretroviral therapies in HIV patients of low health literacy.Crossref | GoogleScholarGoogle Scholar | 10337035PubMed |
Kim SH, Lee A (2016) Health-Literacy-Sensitive Diabetes Self-Management Interventions: A Systematic Review and Meta-Analysis. Worldviews on Evidence-Based Nursing 13, 324–333.
| Health-Literacy-Sensitive Diabetes Self-Management Interventions: A Systematic Review and Meta-Analysis.Crossref | GoogleScholarGoogle Scholar | 27104337PubMed |
Morris NS, MacLean CD, Chew LD, Littenberg B (2006) The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. BMC Family Practice 7, 21
| The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability.Crossref | GoogleScholarGoogle Scholar | 16563164PubMed |
Muscat DM, Shepherd HL, Nutbeam D, Trevena L, McCaffery KJ (2021) Health literacy and shared decision-making: exploring the relationship to enable meaningful patient engagement in healthcare. Journal of General Internal Medicine 36, 521–524.
| Health literacy and shared decision-making: exploring the relationship to enable meaningful patient engagement in healthcare.Crossref | GoogleScholarGoogle Scholar | 32472490PubMed |
Nutbeam D (1998) Health promotion glossary. Health Promotion International 13, 349–364.
| Health promotion glossary.Crossref | GoogleScholarGoogle Scholar |
Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R (2013) The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health 13, 658
| The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ).Crossref | GoogleScholarGoogle Scholar | 23855504PubMed |
Parker RM, Baker DW, Williams MV, Nurss JR (1995) The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. Journal of General Internal Medicine 10, 537–541.
| The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills.Crossref | GoogleScholarGoogle Scholar | 8576769PubMed |
Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB (2002) Association of health literacy with diabetes outcomes. JAMA 288, 475–482.
| Association of health literacy with diabetes outcomes.Crossref | GoogleScholarGoogle Scholar | 12132978PubMed |
Seligman HK, Wang FF, Palacios JL, Wilson CC, Daher C, Piette JD, Schillinger D (2005) Physician notification of their diabetes patients’ limited health literacy. A randomized, controlled trial. Journal of General Internal Medicine 20, 1001–1007.
| Physician notification of their diabetes patients’ limited health literacy. A randomized, controlled trial.Crossref | GoogleScholarGoogle Scholar | 16307624PubMed |
Shea JA, Beers BB, McDonald VJ, Quistberg DA, Ravenell KL, Asch DA (2004) Assessing health literacy in African American and Caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores. Family Medicine 36, 575–581.
Shnaigat M, Downie S, Hosseinzadeh H (2021) Effectiveness of Health Literacy Interventions on COPD Self-Management Outcomes in Outpatient Settings: A Systematic Review. COPD 18, 367–373.
| Effectiveness of Health Literacy Interventions on COPD Self-Management Outcomes in Outpatient Settings: A Systematic Review.Crossref | GoogleScholarGoogle Scholar | 33902367PubMed |
Stormacq C, Wosinski J, Boillat E, Van den Broucke S (2020) Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI Evidence Synthesis 18, 1389–1469.
| Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review.Crossref | GoogleScholarGoogle Scholar | 32813388PubMed |
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H (2012) Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 12, 80
| Health literacy and public health: a systematic review and integration of definitions and models.Crossref | GoogleScholarGoogle Scholar | 22276600PubMed |
van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E (2013) The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey. Journal of Health Communication 18, 172–184.
| The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey.Crossref | GoogleScholarGoogle Scholar | 24093354PubMed |
Visscher BB, Steunenberg B, Heijmans M, Hofstede JM, Devillé W, van der Heide I, Rademakers J (2018) Evidence on the effectiveness of health literacy interventions in the EU: a systematic review. BMC Public Health 18, 1414
| Evidence on the effectiveness of health literacy interventions in the EU: a systematic review.Crossref | GoogleScholarGoogle Scholar | 30594180PubMed |
Wallace LS, Rogers ES, Roskos SE, Holiday DB, Weiss BD (2006) Brief report: screening items to identify patients with limited health literacy skills. Journal of General Internal Medicine 21, 874–877.
| Brief report: screening items to identify patients with limited health literacy skills.Crossref | GoogleScholarGoogle Scholar | 16881950PubMed |
Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, Hale FA (2005) Quick assessment of literacy in primary care: the newest vital sign. The Annals of Family Medicine 3, 514–522.
| Quick assessment of literacy in primary care: the newest vital sign.Crossref | GoogleScholarGoogle Scholar | 16338915PubMed |
