All Relevant Resources for Primary Health Organisations
Resource: The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy
This document, published by the United States National Center for Education Statistics, is a report on the results of the 2003 National Assessment of Adult Literacy.
Resource: Bridging the Health Literacy Gap. Health Literacy for Better Public Health [US]
This is the health literacy blog from the Centers for Disease Control and Prevention. The purpose of the blog is to stimulate ideas for new work in public health and health literacy, build relationships and community, and discuss our successes and challenges in real time. A variety of topics are covered including plain language in the emergency room, attributes of a health literate organisation, writing health literate materials, and health literacy around the world. Most entries are written by Cynthia Baur.
Resource: Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1 – 2014 [US]
Electronic health records provide crucial information to health care providers about a patient’s treatment history and current health status. Recent US legislation places importance on the ‘meaningful use’ of electronic health records. This report (130 pages), from the Institute of Medicine, documents the findings from the first phase of a study into the social determinants of health that influence the meaningful use of electronic health records. The IOM identified a set of domains and measures that capture the social determinants of health. Health literacy is identified as a key measure within the psychological domain. This report briefly summarises the supporting evidence that health literacy influences patient health outcomes and the usefulness of health literacy to health care providers.
Resource: “This does my head in”. Ethnographic study of self-management by people with diabetes
This study by Hinder & Greenhalgh (2012) provides a richer understanding of how people live with diabetes and why self-management is challenging for some. They find that self-management of diabetes is physically, intellectually, emotionally and socially demanding, and without support can be a difficult task to undertake.
Resource: 5th Biennial Wisconsin Health Literacy Summit. April 9-10, 2013 [US]
Wisconsin Literacy, Inc. and the Wisconsin Research and Education Network (WREN) were pleased to co-present the 5th Biennial Wisconsin Health Literacy Summit on April 9-10, 2013 in Madison, Wisconsin. The theme was: Changing Systems, Changing Lives. This event brought together nationally important voices in the fields of health care, adult literacy and health care policy to address health literacy from an interdisciplinary perspective.
Resource: A cross sectional study examining social desirability bias in caregiver reporting of children’s oral health behaviors [US]
In previous research Sanzone et al (2013) found a strong association between caregiver oral health literacy and children’s oral health status, but found a weak association between caregiver oral health literacy and oral health behaviours. The authors hypothesize that this weak association may be due to social desirability bias (caregivers over reporting of behaviours considered to be socially desirable and under reporting undesirable ones). This research article compares caregivers’ responses to traditional oral health behaviours items and newer social desirability bias-modulating items, and examines the association of caregiver literacy with oral health behaviours. Sanzone et al (2013) found that caregivers with lower literacy scores were more likely to avoid brushing their children’s teeth. This avoidance was due to frustration around how and why to brush teeth. Sanzone et al (2013) note that for this study, REALD-30 and REALM are not capable of assessing the wide array of skills that comprise health literacy, including health knowledge, numeracy, and receipt of information via other modes of communication.
Resource: A cross-sectional study of pandemic influenza health literacy and the effect of a public health campaign [Aus]
This study by Jhummon-Mahadnac et al (2012) sought to ascertain the understanding of 2009 pandemic (H1N1) influenza and relevant infection control measures in an emergency department population and to assess the effectiveness of education campaigns in informing the public about the pandemic. This is the first Australian study to correlate the general public’s knowledge of pandemic (H1N1) 2009 influenza with a health department public health campaign. Jhummon-Mahadnac et al (2012) found the knowledge regarding pandemic influenza was high in this emergency department population and positively affected by official campaigns. The authors recommend that pandemic planning should address knowledge gaps and the impression that authorities had exaggerated the public-health threat.
Resource: A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial – 2010 [Aus]
Patient decision aids are interventions designed to help people make informed choices about their health. This article, by Smith et al (2010), examines whether a decision aid designed for adults with low education and limited literacy can help support informed choices and involvement in decisions around screening for bowel cancer. A paper-based interactive booklet and DVD were given to patients. The study found that tailoring decision support information to the needs of limited literacy patients can be effective in supporting informed choices and greater involvement in decision making without increasing patient anxiety.
Resource: A Drug by Any Other Name: Patients’ Ability to Identify Medication Regimens and Its Association with Adherence and Health Outcomes – 2013 [US]
In this study, Lenahan et al investigated hypertension patients’ understanding of and familiarity with their drug regimen. The relationship between patients' identification strategies, self-reported adherence, and health outcomes (blood pressure control, hospitalization) was investigated. Lenahan et al found that patients who were dependent on the visual identification of their prescription medicine reported worse adherence. In addition, they had significantly lower rates of blood pressure control and greater risk of hospitalization. The researchers concluded that the ability to identify prescribed medicines by name may be helpful for screening and responding to patients at greater risk of making medication errors or being less engaged with their regimen for adherence purposes This article was published in the Journal of Health Communication: International Perspectives. Special Issue: Promoting Health Literacy Research to Advance the Field (Volume 18, Supplement 1, 2013).
Resource: A health literacy fable for tomorrow: help the world be healthy with health literacy. Discussion paper – 2014 [US]
This discussion paper (3 pages), by Andrew Pleasant, was written for the Institute of Medicine's Roundtable on Health Literacy. In this paper the author tells the story of an American town that lost health literacy and the health care system went from an emphasis on health care to sick care. The author argues that health literacy can create a path to a happy, healthy future in which good health is not only a human right but also well within everyone’s reach.
Resource: A Maturing Partnership
In this article by Rudd (2002) she traces early innovations in the connection between literacy and health, through some current activities, and provides some suggestions for next steps in the development.
Resource: A new adaptive testing algorithm for shortening health literacy assessments
This article by Kandula et al (2011) describes the development of a new procedure for testing health literacy levels. They found that by using measurement decision theory (MDT), they were able to create an accurate test for health literacy which was 50% shorter than previous tests.
Resource: A pilot study to assess oral health literacy by comparing a word recognition and comprehension tool – 2014 [US]
Oral health literacy is important to oral health outcomes. Very little has been established on comparing word recognition to comprehension in oral health literacy especially in older adults. This pilot study, by Khan et al (2014), aimed to compare methods of measuring oral health literacy in older adults by using the Rapid Estimate of Literacy in Dentistry (REALD-30) tool including word recognition and comprehension and by assessing comprehension of a brochure about dry mouth. This pilot study demonstrated the feasibility of using the REALD-30 and a brochure to assess literacy in a University setting among older adults. Participants had higher scores on the word recognition than on comprehension agreeing with other studies that recognition does not imply understanding.
Resource: A Practical Guide to Informed Consent
This publication focuses on ways to improve full informed consent—both the process and the written forms—as it is employed in everyday (i.e., NOT research) patient care settings. Developed by Temple University, the publication aims to improve the patient-physician communication that is so crucial in creating truly informed patient decision-making about major treatment options, with a focus on health literacy and its barriers.
Resource: A Prescription Is Not Enough: Improving Public Health with Health Literacy (PDF of presentation). Andrew Pleasant – 2013 [US]
This is the presentation that accompanied the unveiling of Pleasant et al's paper "A Prescription Is Not Enough: Improving Public Health with Health Literacy". This paper was commissioned by the Institute of Medicine Roundtable on Health Literacy for their workshop "Implications of Health Literacy for Public Health: A Workshop" (November 21, 2013 in Irvine, California).
Resource: A Prescription Is Not Enough: Improving Public Health with Health Literacy – 2013 [US]
This paper, by Pleasant et al (2013), was commissioned by the Institute of Medicine Roundtable on Health Literacy for their workshop "Implications of Health Literacy for Public Health: A Workshop". Health literacy is always present, but too often neglected. This paper focuses on the use - and the lack of use - of health literacy within efforts to address public health in the United States. In particular, this article focuses on efforts within state, local, tribal, and territorial public health organisations. Overall, while a growing body of evidence strongly suggests that health literacy can be effective in public health when explicitly addressed, the concept and associated best practices of health literacy do not seem to be consistently or universally used within public health organisations. As a result, the effectiveness of state, local, tribal, and territorial public health efforts is reduced and public health suffers.
Resource: A Proposed ‘Health Literate Care Model’ Would Constitute A Systems Approach To Improving Patients’ Engagement In Care – 2013 [US]
Improving health outcomes relies on patients’ full engagement in prevention, decision-making, and self-management activities. Yet relatively few Americans are proficient in understanding and acting on available health information. Koh et al (2013) propose a Health Literate Care Model that would weave health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model). This model calls for first approaching all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them, and then subsequently confirming and ensuring patients’ understanding. For health care organisations adopting this model, health literacy would then become an organisational value infused into all aspects of planning and operations, including self-management support, delivery system design, shared decision-making support, clinical information systems to track and plan patient care, and helping patients access community resources. Koh et al also propose a measurement framework to track the impact of the new Health Literate Care Model on patient outcomes and quality of care.
Resource: A Qualitative Analysis of Health Literacy Issues among Women with Visual Impairments
This article by Harrison et al (2010) provides insight into a qualitative analysis of 15 interviews with women in an attempt to discover what health literacy issues they may have. The women voiced that barriers to their ability to gain information in a format amenable to their processing skills, combined with barriers arising from healthcare providers’ attitudes, undermined their ability to build health literacy capacity
Resource: 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.
Resource: A Review of Health Literacy and Diabetes: Opportunities for Technology
This article by Boren (2009) reviews literature on health literacy and diabetes, as well as identifies opportunities for technology to strengthen information skills and modify behavior to improve diabetes health outcomes. It is noted that there is a connection between health literacy and diabetes but further research needs to be done. It is also stated that technology could help mediate the effect that limited health literacy has on diabetes-related health outcomes.