Developing cartoons for long-term condition self-management information – 2014 [UK]
This paper, from Kennedy et al (2014), examines if the use of cartoons in patient health information materials can help patients manage their long term conditions. The authors outline the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease. Kennedy et al concluded that well-designed cartoons can help patients better manage their conditions and help health professionals address health literacy concerns.
Health literacy and numeracy: key factors in cancer risk comprehension – 2008 [US]
Health literacy, including numeracy, is essential to meaningful participation in shared healthcare decision making and has been accepted as a determinant of health. This study, by Donelle et al (2008), examined the influence of prose literacy and numeracy skills, math anxiety, education level on a patient's ability to comprehend Internet-based colorectal cancer prevention information. The findings of this study highlight the importance of presenting web-based information in a way that accommodates diverse health literacy and numeracy levels.
A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers 
This research article by Flynn et al (2013) analysed twenty-six tools used to support decision making or patient understanding in the treatment of acute ischaemic stroke with intravenous thrombolysis. Analysis found that these tools have been sub-optimally developed. Patient information tools were presented at a level that would not be understood by patients / relatives with low health literacy and numeracy skills. The great majority of tools lacked comprehensive development processes involving clinicians and patients; failed to convey information on a full range of range of outcome states; and did not adhere to good practice on presentation of outcome probabilities. Flynn et al (2013) concluded that the value of tools for supporting decision making would be enhanced by involving patients in design and testing and taking health literacy levels into consideration.
Matching clinical information with levels of patient health literacy [UK]
Good communication between healthcare professionals and patients is central to therapeutic relationships, and patients need to know how to access, understand and make use of services and information to promote and maintain their health. This article, by Jo Protheroe and Gill Rowlands (2013), describes how practising effective communication can improve patient care and how nurses, with their central role in patient advocacy, are well placed to become health literacy champions for their patients and the wider National Health Service. Healthcare professionals should take a ‘universal precautions’ approach to communication with patients, not just when health literacy is obviously low.
Patient information that promotes health literacy [UK]
Health literacy is the ability to make informed health decisions in everyday life. For many patients and carers, decision-making is made more difficult by the fact that high-quality information is unavailable to them. Armstrong and Harries (2013) outline the steps that the Pulmonary Hypertension Association went through when creating patient materials that promote health literacy to help patients and their families make decisions that are well informed.
Characteristics of people with low health literacy on coronary heart disease GP registers in South London: a cross-sectional study [UK]
This study, by Rowlands et al (2013), presents the initial findings of an investigation into the characteristics of low health literacy patients on General Practice Coronary Heart Disease registers in the UK. The authors found that patients with low health literacy have significantly higher anxiety levels and have more and longer consultations with practice nurses. Rowlands et al (2013) found that patients with higher anxiety levels were more likely to have lower literacy levels than patients with lower levels of anxiety. Rowlands et al (2013) noted that the REALM is a test of pronunciation rather than functional literacy skills.
Understanding critical health literacy: a concept analysis – 2013 (UK)
Interest in and debates around health literacy have grown over the last two decades and key to the discussions has been the distinction made between basic functional health literacy, communicative/interactive health literacy and critical health literacy. In this study Sykes et al look at the concept of critical health literacy and offer some clarity of definition upon which appropriate theory, well grounded practice and potential measurement tools can be based.
Exploring the pathways to poor health in the ‘hidden population’ with low literacy – 2011 (Scot)
This thesis (358 pages), by Phyllis Easton (University of Dundee), examines the links between poor health and low literacy capabilities. The findings from 25 in-depth interviews and 2 focus groups with adult learners highlighted the various difficulties that people with low literacy face with written and spoken communication in clinical encounters and in self-care activities. Note: this is a large document and may take a few minutes to download.
Functional health literacy and health-promoting behaviour in a national sample of British adults
The objective of this study by von Wagner et al (2007) was to measure the prevalence of limited functional health literacy in the UK, and examine associations with health behaviours and self‐rated health. The results encourage efforts to monitor health literacy in the British population and examine associations with engagement with preventative health behaviours.
Health care prioritization in ageing societies: influence of age, education, health literacy and culture
The objective of this study by Mak et al (2011) was to examine how Chinese people in Hong Kong view health care prioritization and to compare the findings with those from a United Kingdom survey. They discovered that that most people would give priority to the young over the old in distributing a given amount of healthcare services. To meet the needs of ageing societies and to meet the needs of all users equitably, health care policy needs to acknowledge constraints and the needs for prioritization.