Health Literacy and its Impact on Health
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Health literacy is an expeditiously advancing area, and its meaning has broadened to cover a range of concepts (Jordan, Buchbinder and Osborne, 2010). Health literacy was relatively a newly emerged concept in health promotion research, various problems that are associated with the health literacy, like self care and its relation to health outcomes was identified by the researchers in the recent years (Speros, 2005) and created awareness among health care professionals and governments on the role played by health literacy (Jordan, Buchbinder and Osborne, 2010). Low literacy skills are common in the wealthy countries, and it's quite high in developing nations (Nutbeam, 2008). According to estimation, around ninety million people in USA have poor literacy and have problems in grasping and utilizing health related information (Hawkins, Kantayya and Sharkey-Asner, 2010; Mika et al., 2005). The possible behaviour of the patients and acknowledgement of the information receives in the health care environment and practices, plays a key role in supervising their own health and in monitoring their health status, this is the major factor that addresses the health literacy (Jordan, Buchbinder and Osborne, 2010, p.36). Finding more information on health literacy and the problems associated with it among people with health disparities is quite important (Mika et al., 2005.pg 351). Speros, (2005, p.634) mention that adequate preference is not given to health literacy, which is the most persuasive problem that acts as a wall between the health care systems and the successful functioning of a health consumer. This paper reviews the literature to find the impact of health literacy on individual health and the various approaches in measuring the health literacy.
Methodology: The database searches include, Web of Knowledge, Web of science and Nora to identify articles by using the key word ‘health literacy and its impact on health'. Search was limited to primary research peer reviewed journals with full text online, as health literacy is a recently evolved concept in health promotion (Speros, 2005) search is narrowed to latest years in between 2004 and 2011to address the latest trends and development the topic. Due to the lack of articles on this topic from a particular country, articles from the different parts of the world are selected. The search yielded eight thousand five hundred and twenty three articles published in English out of which twenty six articles were refined from the titles and abstracts. Among these twenty papers are filtered due to the specification of the content according to my criteria. Six papers were selected based on the information available in the article to propose a literature review. This paper consists of both qualitative and quantitative studies. Qualitative research helps in understanding the impact in an individual perspective and Quantitative studies helps in finding the data on the variables of the particular topic.
Inclusion and exclusion criteria: After reviewing abstracts, based on the key issues, a set of inclusion and exclusion criteria is generated. I restricted the search to more recent articles from 2005 to present, and I limited the studies to the articles which explain the impact of health literacy on public health or an individual's perspective in regarding both personal care and clinical services. I generalised the subject by excluding the articles those don't provide original data regarding health outcomes and measurement procedures, the articles that focus on the health literacy in a particular case like older people, pregnant woman, cancer patients etc. are filtered.
Health literacy and its relationship with health outcomes
World Health Organisation stated that health literacy plays a key role in explaining the health inequalities in the community (Nutbeam, 2008). People with low literacy are strongly linked with worse health outcomes, frequent hospitalization and improper using of emergency services than the people with adequate literacy (Hawkins, Kantayya and Sharkey-Asner, 2010, p.734; Mika et al., 2005, p. 351; Nutbeam, 2008, p. 2072; Paasche-Orlow and wolf, 2007, p.S19). Figures from many advanced nations show a link between poor literacy and misusing of health services and health information available (Nutbeam, 2008, P.2072). However, Paasche-Orlow and Wolf (2007, p.S19) state that, though it is associated with poor health outcomes the pathway linking it with literacy is not completely recognised, on the other hand, Mika et al. (2005, p.351) suggests that, patients should develop the ability to communication effectively with their health care providers regarding the status of the health, treatment procedures, follow up of the treatment and self care. Health literacy is one of major factor, which predicts the health status than the other variables which linked with it, like socio economic status, ethnicity and gender (Speros, 2005). At the same time, Paasche-Orlow and Wolf, (2007 p.S19) points out that these complex issues which are interrelated with health literacy make it difficult to distinguish the effects that are independent of those variables. In addition Nutbeam, (2008) states that low literacy is associated with the unfavourable causes of health, which are not related to other types of risk factors and literacy is indirectly linked to the poor socio economic status. According to Jordan, Buchbinder and Osborne (2010, p.41) the abilities of and individual in relation to literacy and in health care setting are understanding and making use of health information. Speros (2005, p.637) explains that self monitoring, reporting of health status, spending fewer amounts on health care, minimising the hospital stays and having proper awareness on various medical issues are the distinct outcomes associated with adequate health literacy.
Measuring health literacy
Various assessment scales and screening tools are developed to estimate the prevalence and the impact of health literacy on different issues like health status, health outcomes and self care of an individual But there's a continuing debate on what should be measured health literacy ass a personal asset or the relationship between individual skills and broader health systems (Jordan, Buchbinder and Osborne, 2010). Mika et al. (2005, p.353) proposes three types of tools available they are; ‘Test Of functional health literacy in adult' (TOFHLA), ‘Wide Range of Achievement Test Reading subtest' (WRAT), ‘The Rapid estimate of adult literacy in medicine' (REALM), These measuring tools not only measure the rate of health literacy in the society they also describe associated factors like chronic disease management, proper using of medications and the involvement in the health screening programmes (Nutbeam, 2008, p.2073). Mika et al. (2005, p.353) claims that none of these instruments either access or explain the absolute or appropriate definition of health literacy. Conversely, Nutbeam (2008, P.2075) put forward that these scales only measure the reading ability of an individual in a health care setting, but they miss assessing the oral communication on medical issues. Mika et al. (2005, p.353) argue that these scales are wording based and made in English and only applies to the people who can read English and cannot be used with people whose first language is not English.
In addition United States developed a national adult literacy scale in 1992 called NALS (Mika et al., 2005), most recently in 2003 NALS was updated by adding twenty six questions related to health, in literacy assessment NALS was the first largest national assessment model particularly designed for health literacy (Hawkins, Kantayya and Sharkey-Asner, 2010; Mika et al., 2005) Whereas TOFHLA may be considered as the most legitimate and trust worthy measure of health literacy presently available (Speros, 2005). According to reports of NALS IN 1992 about 66% of people who are aged fifty and above have minimum or low literacy skills (Hawkins, Kantayya and Sharkey-Asner, 2010). In 1993 the reports shown similar readings, about forty to forty four million Americans (that is about a quarter of the population) are having functional illiteracy and about another fifty million with inadequate health literacy (Mika et al., 2005; Speros, 2005). It has been found by the various results found by the NALS put forward that, people may have difficulty in reading and finding the information that is provided by their health care provider (Hawkins, Kantayya and Sharkey-Asner, 2010; Speros, 2005). Health literacy is described as an independent issue which reflects health issues related to an individual in a health environment. Nut beam (2008, p.2076) suggests still there is lot of work not done regarding the concept of health literacy and its measurement in regarding the individual level.
Conclusion: By reviewing the articles it can be clearly identified that health literacy is an important factor in addressing the health of an individual and various measuring tools explained the consequences associated with it. But still there is some missing gap in explaining the absolute meaning and addressing the health literacy and a little importance is given to it. The studies explain the consequences only from developed countries and no data is available from developing and poor countries which posse's relatively high illiteracy levels it might be important to do more research from the countries with low literacy rates. To create proper awareness on health literacy and to enhance the promotion of health literacy as a public health goal in both rich and poor countries is the final suggestion in this study.
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