This document discusses health literacy and how it is measured. It defines health literacy as the ability to access, understand, evaluate and communicate health information to make informed health decisions. Three common tools used to measure health literacy are described. Populations that tend to have lower health literacy include older adults, immigrants, and those with low incomes. Low health literacy can negatively impact health outcomes, access to healthcare, and healthcare costs. Barriers to developing health literacy are discussed at both the individual and systemic levels.

1. INTEGRITY
HEALTHCARE
CONSULTANTS
HEALTH
LITERACY
Fact
Sheet
#1
FACT
SHEET
#1
HOW HEALTH LITERACY IS MEASURED
The measurement scales typically used to
assess health literacy in adults in Canada and
the United States include:
• International Adult Literacy Skills Survey
(IALSS)
• Rapid Assessment of Literacy in Medicine
measure (REALM)
• Test of Functional Health Literacy in Adults
(TOFHLA).
WHAT
IS
HEALTH
LITERACY?
The
ability
to
understand
and
communicate
health
information
is
essential
to
making
informed
decisions
about
our
health
care
needs.
Health
literacy
refers
to
a
person’s
capacity
to
“access,
understand,
evaluate
and
communicate
information
as
a
way
to
promote,
maintain,
and
improve
health
in
a
variety
of
settings
across
the
life
course”
(CPHA,
2008,
p.
11).
Health
literacy
involves
a
range
of
interrelated
skills,
including:
• Reading
and
comprehending
health
resources
• Understanding
instructions
from
health
care
professionals
about
one’s
health
management
• Navigating
through
the
health
care
system
• Communicating
effectively
with
healthcare
professionals
DID
YOU
KNOW…
It is estimated that only one in eight adults in
Canada (12%) over the age of 65 “appears to
have adequate health literacy skills.”
Source: Canadian Public Health Association, 2008, p.15
LOW
HEALTH
LITERACY:
WHO
IS
AFFECTED?
Aging
populations:
Age
is
an
important
determining
factor
in
one’s
level
of
health
literacy
skills,
often
because
literacy
skills
decline
as
we
age.
As
well,
older
Canadians
tend
to
have
lower
levels
of
literacy
and
education
than
younger
generations
(CPHA,
1998).
Immigrant
populations:
Health
literacy
tends
to
be
lower
among
immigrant
populations,
and
particularly
among
recent
immigrant
groups
whose
mother
tongue
is
not
English
or
French
(PHA
of
BC,
2012;
CPHA,
2008).
Low/precarious
income
recipients:
Socioeconomic
status
can
also
be
a
factor
in
one’s
level
of
health
literacy
skills.
Research
has
shown
that
individuals
scoring
below
average
on
health
literacy
scales
are
more
likely
to
be
receiving
income
support
(CPHA,
2008).

2. 2
Lorem Ipsum
LOW
HEALTH
LITERACY:
WHAT
ARE
THE
IMPLICATIONS?
“Given
that
chronic
ill-­‐health
is
the
leading
cause
of
death
in
Canada,
with
more
than
75%
of
all
deaths
attributable
to
one
of
five
chronic
diseases—
cancer,
heart
disease,
diabetes,
kidney
disease
and
respiratory
disease—the
positive
health
and
lifestyle
implications
for
improved
health
literacy
are
potentially
far-­‐
reaching.”
-­‐Public
Health
Association
of
BC
(2012).
An
Inter-­‐sectoral
Approach
for
Improving
Health
Literacy
for
Canadians,
p.
4.
Low
health
literacy
limits
a
person’s
ability
to
manage
chronic
health
conditions,
use
health
care
resources
effectively,
and
access
appropriate
health
care
services.
As
such,
it
can
have
significant
effects
on
health
outcomes
and
health
care
costs.
 Health
outcomes:
Low
health
literacy
has
been
linked
to
medication
errors,
preventable
hospital
visits,
poor
health
care
management,
and
even
mortality.
Poor
health
literacy
can
also
affect
one’s
prevention
and
self-­‐management
of
chronic
health
conditions
such
as
heart
disease
and
diabetes
(PHS-­‐BC,
2012).
 Accessibility:
Health
literacy
is
fundamentally
about
consistent
access
to
appropriate
health
resources
and
services.
Limited
health
literacy
can
have
implications
for
a
person’s
awareness
of
available
health
care
services
within
the
community,
as
well
as
a
person’s
effective
use
of
health
resources.
For
example,
low
health
literacy
can
affect
an
individual’s
ability
to
read
and
follow
medical
instructions,
understand
medical
consent
forms,
and
keep
track
of
appointments.
 Costs:
Low
health
literacy
can
have
serious
implications
for
health
care
costs.
Research
has
shown
that
in
2009,
low
health
literacy
in
Canada
resulted
in
approximately
8
billion
a
year
in
health
care
costs
(PHS-­‐BC,
2012.)

3. 3
3
BARRIERS
TO
HEALTH
LITERACY
Individuals
with
limited
health
literacy
face
a
range
of
individual
and
systemic
barriers
to
developing
their
literacy
skills.
Individual
barriers
can
include:
• Low
levels
of
formal
education
• Age
• Language
proficiency
(particularly
if
one’s
mother
tongue
is
not
English
or
French)
• Emotional
stresses
or
shame
associated
with
asking
health
professionals
for
clarification
or
guidance
Systemic
barriers
can
include:
• Conflicting
or
unclear
healthcare
information
(particularly
web-­‐based
information
sources)
• Lack
of
access
to
language
programs
for
persons
whose
mother
tongue
is
not
English
or
French
• Complex
health
care
and
hospital
services
that
make
it
difficult
for
individuals
to
navigate
the
system
• Differing
communication
styles
of
health
care
professionals
• Limited
access
to
health
information
(e.g.,
the
“digital
divide”
between
those
who
can
and
cannot
access
web-­‐based
health
resources)
• A
mismatch
between
reading
levels
of
health
information
(e.g.,
informed
consent
forms)
and
the
literacy
levels
of
the
readers
• Unclear
health
information
that
does
not
provide
for
a
comprehensible
plan
for
one’s
self-­‐care
regimens
(CPHA
1998;
2006;
2008,
Nutbeam,
2000;
PHA-­‐BC,
2012)
WE
CAN
HELP.
An
Integrity
Healthcare
Consultants
Case
Study:
“Mrs.
V”
had
a
stroke,
leaving
her
unable
to
swallow
safely
enough
to
give
her
food
by
mouth.
She
was
admitted
to
hospital
in
need
of
an
alternate
method
for
feeding,
otherwise
she
would
become
malnourished
and
dehydrated.
Mrs.
V’s
daughter,
who
acted
as
her
substitute
decision
maker,
was
given
options
to
choose
from,
but
different
doctors
were
saying
different
things.
Conflicting
healthcare
information
is
a
common
barrier
for
patients
and
their
families.
Mrs.
V’s
daughter
was
confused
and
very
concerned
that
she
would
make
the
wrong
decision.
We
met
with
Mrs.
V’s
daughter,
provided
her
with
relevant
research
on
her
different
options,
and
discussed
what
she
felt
would
be
the
best
alternate
feeding
for
her
mother
in
her
current
condition.
Although
it
was
a
difficult
decision
to
make,
she
felt
relieved
that
she
had
taken
the
time
to
retain
our
services
and
get
the
education
that
she
needed
to
make
the
choice
that
she
felt
was
right
for
her
mother.

4. HEALTH
LITERACY
AND
AGING
POPULATIONS
What
does
low
health
literacy
mean
for
Canada’s
aging
population?
Research
has
shown
that
seniors
with
limited
literacy
skills
often
face
unique
challenges
in
terms
of
accessing
and
using
health-­‐related
information.
Consequences
for
health
management:
Limited
health
literacy
can
have
implications
for
how
well
seniors
are
able
to
follow
prescription
instructions
or
comply
with
treatment
plans.
In
many
cases,
older
patients
are
reluctant
to
seek
clarification
from
healthcare
professionals
about
appropriate
prescription
use.
The
Canadian
Public
Health
Association
notes,
“when
low-­‐literacy
seniors
fail
to
take
their
medications
as
prescribed,
it
is
often
because
they
misinterpret
or
forget
the
medication
instructions
and
can’t
decipher
or
understand
the
information
on
the
label”
(CPH,
1998,
p.
3).
Health
literacy
and
shifting
age-­‐related
needs:
As
literacy,
learning
styles
and
cognitive
skills
change
over
time,
many
older
adults
need
health-­‐related
information
designed
to
accommodate
their
shifting
needs.
Research
suggests
that
older
adults
prefer
health
information
that
is
concise,
straightforward
and
not
excessively
technical
(CDC,
2009).
Aging
populations
and
the
digital
divide:
Increasingly,
consumers
are
expected
to
adapt
to
digital
e-­‐health
tools
in
their
own
healthcare
management.
This
demands
a
basic
knowledge
of
web-­‐based
information-­‐seeking
skills
that
are
not
always
accessible
to
many
seniors.
The
“digital
divide”,
a
term
used
to
describe
unequal
access
to
communication
technologies,
can
be
a
considerable
barrier
for
seniors
with
limited
literacy.
“While
many
seniors
remain
healthy
and
happy
well
into
their
senior
years,
illness,
disability,
deteriorating
faculties,
isolation,
declining
mobility
and
diminished
independence
are
facts
of
life
for
others.
The
daily
struggle
to
make
sense
of
the
written
and
spoken
word
makes
it
even
harder
for
those
with
low
literacy
to
deal
with
such
difficulties.”
-­‐Canadian
Public
Health
Association,
1998,
p.
3.
WE
CAN
HELP.
An
Integrity
Healthcare
Consultants
Case
Study:
“Mr.
C”
is
83
years
old
and
had
been
hospitalized
for
several
weeks.
With
the
diagnoses
of
dementia,
his
family
was
worried
about
how
he
would
transition
from
the
hospital
to
home
in
the
care
of
his
wife.
Our
geriatric
specialist,
Mellissa
Turzansk,
went
to
Mr.
C’s
home
to
assess
him
and
review
his
medications.
She
observed
that
Mr.
C
had
transitioned
well
to
his
home
environment
but
was
very
unsteady
on
his
feet,
restless,
and
unable
to
sleep
well.
When
Melissa
reviewed
Mr.
C’s
medication
schedule
she
saw
two
medications
being
taken
together
that
would
cause
an
accumulated
effect,
putting
Mr.
C
at
a
high
risk
of
falling.
She
also
noted
that
a
multivitamin
was
being
taken
with
a
thyroid
medication.
This
was
a
problem
because
iron
in
the
multivitamin
decreases
the
efficacy
of
the
thyroid
medication.
Melissa
provided
suggestions
to
the
family
to
correct
these
two
concerns.
We
followed
up
with
Mr.
C
a
week
later
and
were
told
that,
based
on
our
advice,
he
had
his
medication
altered
by
his
family
doctor.
The
family
was
happy
to
report
that
Mr.
C
was
steady
on
his
feet
and
able
to
sleep
through
the
night.

5. HEALTH
LITERACY
AND
PERSONAL
EMPOWERMENT
“By
improving
people’s
access
to
health
information
and
their
capacity
to
use
it
effectively,
health
literacy
is
critical
to
empowerment.”
-­‐World
Health
Organization
There
is
little
doubt
that
health
literacy
is
essential
to
effectively
managing
one’s
health
care
needs,
making
informed
decisions,
and
ensuring
that
one’s
access
to
health
resources
is
consistent
and
equitable.
Although
health
literacy
is
mediated
by
a
number
of
factors
including
systemic
barriers,
age,
educational
levels,
language
skills
and
socioeconomic
status,
individuals
can
begin
to
take
basic
self-­‐empowering
steps
in
managing
their
health
care
needs.
The
Canadian
Public
Health
Association
advises
that,
for
aging
populations
in
particular,
declining
health
literacy
skills
can
be
managed
by
engaging
daily
in
a
range
of
literacy
activities
such
as
reading
books,
newspapers
and
magazines
(CPHA,
2008).
The
Manitoba
Institute
for
Patient
Safety
suggests
that
individuals
can
become
more
actively
involved
in
their
health
care
management
by
consistently
asking
care
providers
three
simple
questions:

What
is
my
health
problem?

What
do
I
need
to
do?

Why
do
I
need
to
do
this?
SOURCES
Canadian
Public
Health
Association
(1998).
Working
with
Low-­‐literacy
Seniors:
Practical
Strategies
for
Health
Providers.
Ottawa,
ON.
Centers
for
Disease
Control
(2009).
Improving
Health
Literacy
for
Older
Adults:
Expert
Panel
report.
Atlanta:
US
Department
of
Health
and
Human
Services.
Canadian
Public
Health
Association
(2008).
A
Vision
for
a
Health
Literate
Canada:
Report
of
the
Expert
Panel
on
Health
Literacy.
Ottawa,
ON.
Nutbeam,
D.
(2000)
Health
Literacy
as
a
Public
Health
Goal:
A
Challenge
for
Contemporary
Health
Education
and
Communication
Strategies
into
the
21st
Century,
Health
Promotion
International,
Vol.
15,
no.
3,
259-­‐276.
Manitoba
Institute
for
Patient
Safety
(nd).
Retrieved
from:
http://www.safetoask.ca/
Public
Health
Association
of
BC
(2012).
An
Inter-­‐sectoral
Approach
for
Improving
Health
Literacy
for
Canadians:
A
Discussion
Paper.
Victoria,
BC.
World
Health
Organization
(nd).
Track
2:
Health
Literacy
and
Health
Behavior.
Retrieved
from:
http://www.who.int/healthpromotion/conferences/7gchp/track2/en/
Prepared
by:
MacMillan
Research
Design
–
www.macmillanresearch.com