Faculty of Arts and Social Sciences, University of Technology, Sydney. Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.

1. Researching health literacy and
numeracy as social practices
Stephen Black & Keiko Yasukawa
University of Technology, Sydney
Health Literacy Network: Crossing Disciplines, Bridging Gaps, University of
Sydney, 26 November 2013
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2. Health literacy and everyday lives: some examples
Jeff lives in the UK and describes himself as an alcoholic with depression and a disability.
He’s in his early 40s and doesn’t work. He lives in sheltered housing and attends a
number of support organisations for his drug addiction, psychological problems and
respite care.
Researcher: Do you ever have to fill in any forms when you go to these various places
(meaning the respite care, the day centres, the psychiatrists etc)?
Jeff: No I don’t fill in forms. They (referring to his key workers) do that, all I do is sign it.
Researcher: So do you ever read any of those things they put in the medicine packets,
you know all those information…?
Jeff: No but me key workers does sometimes.
Researcher: So they do it for you?
Jeff: Yes because the writing is so small I can’t see the writing, so they do it for me.
It became very clear through the course of the interview that Jeff’s support workers (his
key workers, as he calls them) removed any need on his part to engage directly with
texts. Jeff was happy with this.
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Papen, U & Walters, S 2008 Literacy, learning and health, London: National Research &
Development Centre. Page 41

3. Health literacy and everyday lives
(A patient with a long term health condition attending an information session)
I don’t do it myself but whoever is with me will write things down. And so we can
remember what they’ve actually said because I never remember and when you are
there and they are saying really scary things you don’t remember. (Edwards et al.
2013)
(An Iranian man new to the UK accessing health services)
Mehdi’s father accompanied him to the doctor and dentist, as he spoke more
English than Mehdi and was more familiar with the local accent. Mehdi’s mother
went to the pharmacy to buy him some medicine for his cold and she read the
dosage and contraindications for him. A neighbour, also from Iran, passed on
information about dentists and gave them several dentists’ telephone numbers
when Mehdi needed to register with one. (Papen & Walters 2008: 37)
(Comment on Arabic-speaking Australians accessing health)
Participants also relied on their children and family members to purchase their
medicines from the pharmacy and interpret English verbal or written information
about medicines. (El Samman et al. 2012)
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4. Health numeracy & the negotiation of risks
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5. Perzynski, AT, Terchek, JJ, Blizen, CE & Dawson, NV (2013) Playing the
numbers: how hepatitis C patients create meaning and make
healthcare decisions from medical test results, Sociology of Health &
Illness, 35(4), 610-627.
‘It was high (73), and he
tested me again for
hepatitis. I was diagnosed
with Hep C in November. I
have had another ALT test
and it went up to 146.
God certainly has a way
of getting my attention.’
(p. 619)
Medical tests can help patients understand
risks and provide an apparent island of
certainty in a sea of confusion and
frustration. However, understandings of
numerical results seem to go through a
translation process whereby numeric
techno-scientific symbols and replaced by
more lay-friendly words and phrases that
are integrated into the patient’s sociocultural context. Numeric risks become
feelings. The clinical meaning of a test
result can be retained or partially or wholly
lost in translation. (p 623)
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6. Parsons, E & Atkinson, P (1992) Lay constructions of genetic
risk, Sociology of Health & Illness, 14(4), 437-455.
‘Pamela: So does that
mean that I’m not a
very high risk? The
doctor thought for a
moment and said –
“well, we consider 10
per cent to be high so
you must be
moderately high”’
(p. 444)
Pamela was trying to translate
formal probability analysis into
something that was meaningful
to her. The doctor was defining
her carrier risks as ‘moderate’
and yet her sister, with a risk of
less than 1 per cent, had given
birth to an affected boy.
Mathematical probability
appeared meaningless in the
light of her personal experience.
(p. 444)
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7. Health literacy and numeracy from a
social practices approach
Health literacy and numeracy is:
• always ‘situated’ in the everyday lives of individuals and
communities
• not just a matter of an individual’s reading, writing or maths
skills
• often collective and collaborative. In other words it can be
seen as ‘distributed’ across social networks
• inclusive of an affective dimension and is shaped by and
shapes people's identities
• not necessarily a ‘problem’ for people
• dependent on local culture
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8. A social practices definition
A quote from Papen, U and Walters, S (2008) Literacy, learning
and health, London: NRDC
Health literacy is shared knowledge and understanding, it
resides in the family, the neighbourhood and the social network
of a patient. An individual’s health literacy could thus be seen as
the sum of what she knows and is able to do on her own and
what she is able to achieve with the support from friends, family
and other significant people in her environment. (p.57)
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9. References
Edwards, M, Wood, F, Davies, M and Edwards, A (2013) ‘Distributed health
literacy’: longitudinal qualitative analysis of the roles of health literacy
mediators and social networks of people living with a long-term health
condition, Health Expectations, online 22 May 2013 doi: 10.1111/hex.12093
El Samman, Chaar, B, McLachlan, A & Aslani, P (2012) Medicines and disease
information needs of older Arabic-speaking Australians, Australian Journal on
Ageing, online doi: 10.1111/j.1741-6612.2012.00587.x
Papen, U & Walters, S (2008) Literacy, learning and health, London: NRDC
Parsons, E & Atkinson, P (1992) Lay constructions of genetic risk, Sociology of
Health & Illness, 14(4), 437-455.
Perzynski, AT, Terchek, JJ, Blizen, CE & Dawson, NV (2013) Playing the numbers:
how hepatitis C patients create meaning and make healthcare decisions from
medical test results, Sociology of Health & Illness, 35(4), 610-62
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