Health Literacy

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Health Literacy

• Health Literacy What is it?
• The capacity of individuals to obtain, interpret,
  and understand basic health information and
  services and the competence to use such
  information and services in ways which enhance
  health. Joint Committee on National Health
  Education Standards (1995)
• Desired outcome of the National Health Education
  Standards Project
• NHES outline skills and knowledge needed to
  become health literate
• The degree to which individuals have the capacity
  to obtain, process and understand basic health
  information and services needed to make
  appropriate health decisions Seldon et al., 2000
  used by the Institute of Medicine, 2004 and in
  Healthy People 2010, U.S. Department of Health
  and Human Services, 2000

• Background The Need
• Low health literacy is a wide spread problem,
  affecting more than 90 million adults in the
  United States (Kirsch, Jungeblut, Jenkins
  Kolstad, 1993).
• Low health literacy results in patients
  inadequate engagement in, and benefit from,
  health care advances as well as medical errors.
• Low health literacy is likely to be a major
  contributor of adverse health outcomes (AMA,
  1999 Baker, Gazmararian, Williams, Scott,
  Parker, Green, Ren, Peel, 2002 Baker, Parker,
  Williams, Clark, 1998).
• Research has linked low or limited health
  literacy with such adverse outcomes as poorer
  self-management of chronic diseases, less healthy
  behaviors, higher rates of hospitalizations, and
  overall poorer health (Gazmararian, Baker,
  Williams, Parker, Scott, Green, Fehrenbach, Ren,
  Koplan, 1999 Schillinger, Grumbach, Piette,
  Wang, Osmond, Daher, Palacios, Sullivan,
  Bindman, 2002 Williams, Parker, Baker, Pitkin,
  Coates, Nurss, 1995).

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Basic Premise NIH PAR 04-116 Understanding and
Promotion Health Literacy (RO1)Many factors
affect individuals ability to comprehend, and in
turn use or act on, health information and
communication.

• Proficiency in reading, writing, listening,
  interpreting, oral communication, and visual
  analysis is necessary as the modern health system
  typically relies on a variety of interpersonal,
  textual, and electronic media to present health
  information.
• Individuals and families both must be able to
• Communicate with health professionals
• Understand the health information in mass
  communication
• Understand how to use health-related print,
  audiovisual, graphical and electronic materials
• Understand basic health concepts (e.g., many
  health problems can be prevented or minimized)
  and vocabulary (e.g., about the body, diseases,
  medical treatments, etc.) and
• Connect this health-related knowledge to health
  decision-making and action-taking.
• Health literacy skills include
• Gathering and comprehending health information
• Speaking and sharing personal information about
  health history and symptoms
• Acting on information by initiating appropriate
  follow-up visits and conveying understanding back
  to the information source
• Making decisions about basic healthy behaviors,
  such as healthy eating and exercise
• Engaging in self-care and chronic disease
  management

How do these medical-based premises align with
the standard-based school health education
program? How can the public health care system
and the education system support one another?
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Vision for a Health-Literate AmericaInstitute of
Medicine, 2004

• We believe a health-literate America would be a
  society in which
• Everyone has the opportunity to improve their
  health literacy.
• Everyone has the opportunity to use reliable,
  understandable information that could make a
  difference in their overall well-being, including
  everyday behaviors such as how they eat, whether
  they exercise, and whether they get checkups.
• Health and science content would be basic parts
  of K_12 curricula.
• People are able to accurately assess the
  credibility of health information presented by
  health advocate, commercial, and new media
  sources.
• There is a monitoring and accountability for
  health literacy policies and practices.
• Public health alerts, vital to the health of the
  nation, are presented in everyday terms so that
  people can take needed action.
• The cultural contexts of diverse peoples,
  including those from various cultural groups and
  non-English-speaking peoples, are integrated in
  to all health information.
• Health practitioners communicate clearly during
  all interactions with their patients, using
  everyday vocabulary.
• There is ample time for discussions between
  patients and health care providers.
• Patients feel free and comfortable to ask
  questions as part of their healing relationship.
• Rights and responsibilities in relation to health
  and health care are presented or written in
  clear, everyday terms so that people can take
  needed action. P.13

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Strategies for Health Literacy Instruction
Institute of Medicine, 2004

• There is sound justification for embedding health
  literacy instruction into existing literacy
  instruction for children and adults.
• Research shows that learners retain and apply
  information best in contexts similar to those in
  which they learned it Beretier, 1997 Mayer and
  Wittrock, 1996 Perkins, 1992.
• Reading and writing skills should be taught in
  the context of texts and literacy purposes that
  readers will encounter in the real world.
• Health texts (and/or articles, papers, etc.) and
  purposes for reading them make up one of those
  real-life literacy domains.
• Embedding health literacy instruction can be done
  with the two types of literacy instruction needed
  to improve health literacy.
• Basic print literacy instruction
• Literacy instruction in text types common to the
  field of health literacy (e.g., prescriptions,
  recipes, instructions, etc.)
• Science education provides a clear opportunity
  for implementation of health literacy education
  programs and content.
• It is possible to evaluate basic literacy and
  functional print literacy, and it is important to
  be clear when conceptualizing and building valid
  assessments.
• SCASS-HEAP was highlighted.

• Future SCASS-HEAP PD and Resource Development
• Should SCASS-HEAP focus on developing more
  assessment items that can be used to assess
  health literacy? Are there additional
  descriptors that need to be added to the
  framework that are specific to health literacy?
• How can we build new assessments that incorporate
  or emphasize health literacy (e.g., Lexile
  reading levels, instructions for item writers
  that incorporate reading/writing rubrics, science
  integration, etc.)?

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Accountability in School Health EducationHealth
Knowledge and Skills or Health Behavior

• K-12 school health educators are denying the
  importance of their role in influencing youth
  behavior, ignoring the needs of students, and
  failing to address the expectations of parents
  and communities Gobernali, et al., 2005, p. 211.
• Increasing health knowledge, skills, and
  attitudes is a fundamental purpose of schools,
  irrespective of whether measured health behaviors
  of health outcomes also improve as a consequence
  Kolbe, 2002, p. 6.
• We maintain that classroom health educators are
  not denying their important role of primary
  prevention for public health, e.g., influencing
  students health behaviors. However, they have to
  contend with the real world of education reform
  that challenges them to teach to health education
  standards and formally assess student learning.
  Our premise is that health educators are
  contributing to our nations health as never
  before they are providing students with the
  health knowledge and health skills that are
  prerequisites for becoming health literate and
  using assessment tools to demonstrate
  effectiveness. In the school health educators
  world, accountability equates to improved student
  knowledge and skills. To expect them to be held
  accountable for students behavior is
  professional suicide. Benham-Deal Hudson, in
  press.

What is the purpose of classroom based health
education? Should the health education teacher be
held accountable for students health
behavior? Should the health education teacher be
held responsible for students health
behavior? How can the public health system and
the school health education system work together
to achieve health literacy?