Health Literacy as a Complex Practice
As attention to health literacy grows as an area for policy intervention,policy discourse continues to draw on skills deficit and patient compliance, buttressed by the dominant political discourse of individual responsibility. But for patients, the health domain is interwoven with linguistic challenges, significant affective issues, underlying cultural dimensions, political and economic exigencies, variable access to resources, and cognitive and situated complexity. From these perspectives, this article reports on findings of an ongoing study of health literacy demands in the Midlands region of the North Island of New Zealand, an area of high ethnic and socio-economic diversity.The study focuses on patients with diabetes and cardiovascular disease - two chronic areas strongly associated with ‘failure to care’ and identifed as having reached epidemic proportions. It analyses work to date:health professionals’ conceptions of and responses to perceived patients’ health literacy needs, and health information documents for patients. Implications of the study support the need for improvement in language and literacy skills among patients, but also the recognition of complexity and a collective responsibility for effective health communication.
Adams, R J, Appleton, S I, Hill, C L, Dodd, M, Findlay, C, and Wilson, D H (2009) Risks Associated with Low Functional Health Literacy in an Australian Population, Medical Journal of Australia, vol 191, pp 530534.
Baker, D, Gazmararian, J, Williams, M, Scott, T, Parker, R, Green, D, Ren, J, and Peel, J (2002) Functional Health Literacy and the Risk of Hospital Admission among Medicare Managed Care Enrolees, American Journal of Public Health, vol 92, no 8, pp 1278-1283. http://dx.doi.org/10.2105/AJPH.92.8.1278
Balatti, Jo, Black, Stephen, and Falk, Ian (2009) A New Social Capital Paradigm for Adult Literacy: Partnerships, policy and pedagogy, NCVER, Adelaide.
Bass III, Pat, Wilson, John and Griffith, Charles (2002) A Shortened Instrument for Literacy Screening, Journal of General Internal Medicine, vol 18, pp 1036-1038. http://dx.doi.org/10.1111/j.1525-1497.2003.10651.x
Black, Stephen, Innes, Christine, and Meenakshi, Chopra (2008) Diabetes Literacy: A partnership approach to educating culturally and linguistically diverse people about the risks and prevention of type 2 diabetes, TAFE NSW Northern Syney Institute and Northern Sydney Central Coast Area Health Service, Sydney.
Black, Stephen & Yasukawa, Keiko (2011) Beyond deficit approaches to teaching and learning: Literacy and numeracy in VET courses, Rendezvous Hotel, Melbourne, April 2011, in Bringing Australia's VET research community together, AVETRA executive, ed, AVETRA, retrieved 4 July 2011 from http://avetra.org.au/wp-content/uploads/2011/05/62.00.pdf
Bundesmann, R and Kaplowitz, S (2011) Provider Communication and Patient Participation in Diabetes Self-care, Patient Education and Counseling, vol 85, no 2, 143-147, retrieved 7 October 2011http://www.ncbi.nlm.nih.gov/pubmed/21035296#, http://dx.doi.org/10.1016/j.pec.2010.09.025
Casey, H, Olga, C, Eldred, J, Grief, S, Hodge, R, Ivanic, R, Jupp, T, Lopez, D, and McNeil, B (2006) You Wouldn't Expect a Maths Teacher to Teach Plastering: Embedding literacy and language in post 16 vocational programmes -the impact on learning and achievement, National Research and Development Centre for Adult Literacy and Numeracy, London.
Diabetes New Zealand (2005) It's time to shed some light on Type 2 diabetes, Wellington, NZ.
Doak, C, Doak, L, and Root J (1996) Teaching patients with low literacy skills, 2nd ed, J B Lippincott, Philadelphia, PA.
Freebody, Peter and Freiberg, Jill (1999) Health Literacy and Social Practice: Response to Nutbeam, Literacy and Numeracy Studies, vol 9, no 2, pp 57-66, retrieved from http://search.informit.com.au.ezproxy.waikato.ac.nz/fullText;dn=2 00105398;res=AP
Hill, T E (2010) How Clinicians Make (or Avoid) Moral Judgments of Patients: Implications of the evidence for relationships and research, Philosophy, Ethics and Humanities in Medicine, vol 5, no 11, retrieved 9 October 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2914676/. doi: 10.1186/1747-5341-5-11. http://dx.doi.org/10.1186/1747-5341-5-11
Johns, T and Davies, F (1983) Text as a Vehicle for Information: The classroom use of texts in teaching reading in a foreign language, Reading in a Foreign Language, vol 1, pp 1-19.
Ministry of Health (2010) Korero Marama Health Literacy and Maori: Results from the 2006 Adult Literacy and Life Skills Survey, retrieved 27 March 2010 from http://www.moh.govt.nz/moh.nsf/pagesmh/9932/$File/korero-marama.pdf
National Patient Safety Foundation (nd) Ask Me 3, retrieved 30 September 2011 from http://www.npsf.org/askme3/
Nielsen-Bohlman, Lynn, Panzer, Allison, Kindig, David, eds (2004) Health Literacy: A Prescription to End Confusion, Report Brief, Washington, DC: National Academies Press. Retrieved 7 December 2010 from http://www.iom.edu/Reports/2004/Health-Literacy-A-Prescription-to-End-Confusion.aspx
Nutbeam, Don (1999) Literacies Across the Lifespan, Literacy and Numeracy Studies, vol 9, no 2, pp 47-55.
Osborne, H (2010) In other words... Screening for health literacy using the newest vital sign, retrieved from http://www.healthliteracy.com/article.asp?PageID=6766
Paasche-Orlow, M K and Wolf, M S (2007) The Causal Pathways Linking Health Literacy to Health Outcomes, American Journal of Health Behavior, vol 31, pp 1926. http://dx.doi.org/10.5993/AJHB.31.s1.4
Paltridge, B (1995) Analyzing genre: A relational perspective, System, vol 23, no 4, pp 503-511. http://dx.doi.org/10.1016/0346-251X(95)00036-J
Papen, Uta (2009) Literacy, learning and health: A social practices view of health literacy, Literacy and Numeracy Studies, vol 16, no 2, vol 17, no 1, pp 19-34.
Papen, Uta and Walters, Sarah (2008) Understanding Literacy and Health, NRDC, London, retrieved from http://www.nrdc.org.uk
Parker, Ruth, Baker, David, Williams, Mark and Nurss, Joanne (1995) The Test of Functional Health Literacy in Adults, Journal of General Internal Medicine, vol 10, no 10, pp 537-541. http://dx.doi.org/10.1007/BF02640361
Sandlin, J and Clark, M (2009) From Opportunity to Responsibility: Political master narratives, social policy, and success stories in adult literacy education, Teachers College Record, vol 111, no 4, pp 999-1029.
Schillinger, D, Grumbach, K, Piette, J, Wang, F, Osmond, D, Daher, C, Palacios, J, Diaz Sullivan, G, and Bindman, A B (2002) Association of Health Literacy with Diabetes Outcomes, Journal of the American Medical Association, vol 288, no 4, pp 475482. http://dx.doi.org/10.1001/jama.288.4.475
Secretary General of the UN (2011, May). Prevention and control of non-communicable diseases, United Nations General Assembly, New York.
Sefton, R, Waterhouse, P, and Deakin, R (1994). Breathing Life into Training: A model of integrated training, National Automotive Industry Training Board, Melbourne.
The Centre for Literacy (nd) Health Literacy, retrieved 7 October 2011 from http://www.centreforliteracy.qc.ca/health_literacy
The Scottish Government & Jennifer Waterton Consultancy. (2009). Health Literacy -A scoping study final report, Scotland, retrieved 22 September 2010 from www.scotland.gov.uk/Resource/Doc/296717/0092261.pdf
Turner, Jane and Kelly, Brian (2000) Emotional Dimensions of Chronic Disease, Western Journal of Medicine, vol 172, no 2, pp 124-128. http://dx.doi.org/10.1136/ewjm.172.2.124
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2010) National Action Plan to Improve Health Literacy, Washington, DC, retrieved from http://www.health.gov/communication/HLActionPlan/
Ventola, Eija (1987) The Structure of Social Interaction: A systemic approach to the semiotics of service encounter interaction, Pinter, London.
Weiss, B D, Mays, M Z, Martz, W, Castro, K M, DeWalt, D A, Pignone, M P, Mockbee, J, and Hale, F A (2005) Quick Assessment of Literacy in Primary Care: The newest vital sign, Annals of Family Medicine, vol 3, no 6, pp 514522. http://dx.doi.org/10.1370/afm.405 & quot;
Wizowski, Lindsay, Harper, Teresa, Hutchins, Tracy (2008) Writing health information for patients and families, 3rd ed, Hamilton Health Sciences, Hamilton, Canada, retrieved 15 February 2011 from www.hamiltonhealthsciences.ca
Zarcadoolas, Christina (2010) Ask Me 3 Fails to Live up to its Billing, retrieved 10 October 2011 from http://publichealthliteracy.blogspot.com/2010/03/ask-me-3-fails-to-live-up-to-its.html