Health Literacy is a Complex Variable
Literacy is malleable. Certainly, one can learn and improve literacy skills. At the same time, literacy skills should not be considered in isolation. A measure of one’s literacy skills can vary, for example, based on the complexity of the text, the communication skills of the speaker, and/or environmental distractors. Consequently, literacy should not be considered or measured as a characteristic of an individual alone.
Literacy is dependent on the interaction between a reader and a text or between a speaker and a listener. Poor or complex writing will influence any measure of reading skills. A good listener might still struggle when the speaker is erratic or poorly organized. In addition, literacy is also influenced by the context within which activities take place. Background noise, for example, can be distracting. Illness or fear can influence one’s ability to apply existing skills. Institutional characteristics can be intimidating or limiting. Consequently, we must broaden our concept of health literacy.
Health literacy is complex and is dependent on a number of key factors:
- Literacy skills of individuals – the ability to read, write, speak, listen, calculate, problem solve, use current technology.
- Communication skills of health professionals – the ability to present clear health information and data in talk and/or in written format; the skill to explain in everyday words, the ability to check for clarity and comprehension.
- Health texts: the written word in print or on-line, the spoken word in person or over the air waves, the various data displays [such as charts, graphs and diagrams] -with attention to vocabulary, the use of numbers and numeric concepts, organization, design, voice and tone.
- Tasks: the activities people are expected to do as they use the text [proximal tasks] and the activities people are expected to engage in after using the text [distal tasks].
- Context: the environment within which health activities take place – with attention to institutional characteristics, norms, practices, and policies and to broader systemic issues.
To get a true picture of how health literacy influences health related decisions, activities, and outcomes – we must consider all of these factors and develop measures for each of them. The early emphasis on the skills or abilities of individuals is being replaced by an understanding that a variety of key components of the literacy exchange shape the concept of health literacy and likely contribute to health outcomes.
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