The field of health literacy has come a long way in a short time. But many advances are still needed to reach a complete understanding and use of health literacy. For instance, it is a too common misunderstanding to assume that health literacy is simply reading and writing information about health. Health literacy is an important and complex social determinant of health that incorporates a range of skills and abilities.
Additionally, health literacy is not simply an individual characteristic or something some people are lacking. Health literacy is a product of individuals and their social, cultural, political, educational, and organizational contexts. That means to truly evaluate health literacy initiatives, not only individual skills but also the context those skills exist within needs to be assessed.
Health literacy is the wide range of skills and competencies that people develop to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks, and increase quality of life. The argument for this approach is simple. If people can't access information, they don't have an opportunity to understand it. If they can't understand it in a fundamental sense, they are not able to evaluate its utility in the context of their lives. If they can't make that critically important evaluation, there is little to no chance that they will put the information to use in making informed decisions about their own, their family's and their community's health and well-being. That also means it is critically important to learn where along that path people encounter barriers in order to successfully design or improve a health literacy program.
Barriers to putting that range of skills into use in everyday life are unfortunately common, perhaps even universally present in the health care system in the United States - Cleveland is no exception. Thus, there are many fronts to address health literacy, but generally the domains of fundamental, civic, scientific, and culture can serve as an organizing rubric. Briefly, these domains are:
Perhaps most importantly, a health literacy perspective often finds that how things were done in the past were lacking or inappropriate. That is perhaps most true of traditional top-down didactic health education programming. To resolve that and move forward, there are, or at least should be, two golden rules to guide those addressing health literacy. First, know your audience (and that means know them well) and, second, involve them early and often. That means, program designers should not develop an intervention without first doing extensive research with the people they hope to reach.
A best practice is to start with the intended audience and engage them in developing and testing program materials. Developing programs and materials isolated from the community - for example a small group of professionals working in an office with little or no direct community contact - is not sufficient. Some mechanism must be developed to gain an understanding of and empathy for the situation of the community members the program is hoping to work with. That takes work, which nearly always encounters resistance from those who are satisfied with or by the status quo.
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