Great discussion!

A two-part definition, such as this, really helps keep the related but (as I see them) distinct skills of patients and health professionals separate. This is useful for a number of reasons:

First, if we are ever going to be able to operationalize health literacy in a meaningfully measurable way, keeping the patient and provider domains separate will be helpful. For example, to design a tool to measure what HL really is (as opposed to current tools, which provide proxy measures), one will want to apply the tool either to patients or providers, but likely not both simultaneously. Using a definition which entangles patients and providers will make the design of such a tool more difficult, and ultimately less useful in many settings. 

Second, applying the term "literacy" to the skills and activities of health care professionals is fraught with problems, as I'm sure any linguists on the list will agree.

I would argue that patients can have "health literacy", but that the corollary set of skills possessed by health care professionals is better described as "clear communication".

The NYC Mayor's office definition below could be nicely modified to state that: 

"Health literacy is the ability of individuals to read, understand, and act 
upon health-related information.  Health literacy is INTIMATELY LINKED to the 
capacity of professionals and institutions to communicate effectively so 
that community members can make informed decisions and take appropriate 
actions to protect and promote their health."

The down-side to such a two-part definition is that some people may choose to omit the second part, thus diminishing the emphasis on the role of the health professional. 

Keep up the great work!

Cliff
Cliff Coleman, MD, MPH
Assistant Professor
Department of Family Medicine
Oregon Health & Science University
Richmond Family Health Center
3930 SE Division St
Portland, OR  97202




-----Original Message-----
From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Jill Raufman
Sent: Thursday, December 04, 2008 1:06 PM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 2560] Re: WednesdayQuestion: Lookingfor CompellingHealth Literacy Facts

I'd like to mention that health literacy as defined by the NYC Mayor's 
Office (one of my favorite definitions) is as follows:

Health literacy is the ability of individuals to read, understand, and act 
upon health-related information.  Health literacy also refers to the 
capacity of professionals and institutions to communicate effectively so 
that community members can make informed decisions and take appropriate 
actions to protect and promote their health.




>From: "Hudson, Stanton" <HudsonST at health.missouri.edu>

>Reply-To: The Health and Literacy Discussion List <healthliteracy at nifl.gov>

>To: "The Health and Literacy Discussion List" <healthliteracy at nifl.gov>

>Subject: [HealthLiteracy 2558] 

>Re:WednesdayQuestion:	Lookingfor	CompellingHealth Literacy	Facts

>Date: Thu, 4 Dec 2008 13:06:35 -0600

>

>I think Dr. Schwartzberg addressed a very important part of health

>literacy, as empowerment is a key to success with both the public and

>professionals.

>Stan

>

>Stan Hudson, M.A.

>Project Director

>Center for Health Policy

>DC 375.10

>CE540 Clinical Support & Education Building

>University of Missouri

>Columbia, Missouri  65212

>phone: (573) 884-7549

>fax: (573) 884-0474

>

>________________________________

>

>From: healthliteracy-bounces at nifl.gov

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Joanne

>Schwartzberg

>Sent: Thursday, December 04, 2008 11:57 AM

>To: The Health and Literacy Discussion List

>Subject: [HealthLiteracy 2556] Re:WednesdayQuestion: Lookingfor

>CompellingHealth Literacy Facts

>

>

>I would like to broaden the definition to include the concept of the

>ability to act on the medical decisions made. It is not enough to

>understand the information and make an appropriate decision; patients,

>professionals and institutions need to be able to know how to actually

>carry out that decision successfully. Part of the concept of literacy in

>the 1991 definitions was to enable the person to function in society and

>obtain their full potential. That concept did not get into the health

>literacy definition (except for the early AMA "read, understand and act

>on health care information"..) but it is crucial.

>

>Joanne

>

>Joanne G. Schwartzberg, MD

>Director, Aging and Community Health

>American Medical Association

>515 N. State St.

>Chicago, IL  60610

>312-464-5355

>fax: 312-464-5841

>Joanne.Schwartzberg at ama-assn.org

>

>

>________________________________

>

>From: healthliteracy-bounces at nifl.gov

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of William Smith

>Sent: Thursday, December 04, 2008 6:06 AM

>To: healthliteracy at nifl.gov

>Subject: [HealthLiteracy 2551] Re: WednesdayQuestion: Lookingfor

>CompellingHealth Literacy Facts

>

>

>Having been on the IOM committee with Rima I want to emphasis the

>importance of this finding from the report.  Health literacy is not a

>function of an individual in our minds - but of individuals,

>organizations, and communities.  I wish many times now that we had found

>a way to put that in the definition and not in an explanatory note.

>

>The definition as it stands, as all of you know is:

>

>Health literacy is the degree to which individuals have the capacity to

>obtain,process, and understand health information and services needed to

>make appropriate health decisions.

>

>It is just as important to ask-  Do I work in a health literate

>organization?    Is my community health literate?  Is my program health

>literate?  Rima and I, at least the two of us perhaps others, have been

>working on measurement tools to measure an organization/community's

>health literacy. Despite the rhetoric we continue to rely on

>measurements that focus only on the individual.

>

>In the definition we used the word "individuals"  and everyone

>interprets that to be patients.  Again we failed to clarify that a

>physician is an individual. Nurses, pharmacists, family members,

>pharmaceutical executives are also "individuals" who require "the

>capacity to obtain, process, and understand basic health

>information....."  A physician who does not have the capacity to illicit

>useful information from a patient, to understand what impact information

>he gives a patient will have on that patient's compliance, is not health

>literate.  This is equally true for those us working in prevention - we

>too are individuals who require the capacity to obtain, process and

>understand health information about our audiences if we are ever to have

>a health literate America.

>

>There is a second aspect of the definition which is often overlooked.

>It is the word "services".  Too much of our energy is going into making

>written materials clear and in  training disadvantaged groups to

>understand the stupid things we tell them.  The services word places

>emphasis not on what we say, but on what we do to help people make

>appropriate health decisions.  I would love to see a marketing study of

>the service aspect of health literacy as well as the information aspect.

>

>We should have done a better job of making this clear in the definition

>itself.  For me today, after speaking to dozens of groups, health

>literacy is the:

>

>"capacity of individuals, organizations and communities to obtain,

>process, understand and share basic health information and services

>needed to make appropriate health decisions. "

>

>Discussion of photonovels is interesting, but the real pay-off is the

>re-structuring of our health care system so people can protect

>themselves from disease and it consequences.

>

>

>Wm. Smith

>Executive Vice President

>Academy for Educational Development

>1825 Connecticut Ave., NW

>Washington, D.C. 20009

>

>Organize policy until self-interest

>does what justice requires.

>Phone: 202-884-8750

>Fax: 202-884-8752

>e-mail: bsmith at aed.org

>

> >>> "Rima Rudd" <RRUDD at hsph.harvard.edu> 12/3/2008 3:59 PM >>>

>Hello...

>I will certainly think of my 'favorite' fact but I cannot resist

>commenting on the one just posted.

>

>It is not correct to state that people cannot do any of the tasks noted.

>A more appropriate way to say this is "people below level X have

>difficulty completing this task with accuracy and consistency" .

>

>What is missing from this insight [and it is valuable measure and an

>important insight] is the critical finding from over 800 published

>studies that health materials are generally poorly written and designed.

>

>so... this does lead to my favorite assertion taken from the IOM report:

>

>Health literacy is a shared function of social and individual factors.

>page 4

>or

>Health literacy is a shared function of cultural, social, and individual

>factors. Both the causes and the remedies for limited health literacy

>rest with our cultural and social framework, the health and education

>system that serve it, and the interactions between these factors. page

>32

>

>

>in addition:

>The cost research is not firmly established nor uniformly accepted. It

>is not possible, for example, to differentiate between costs due to

>medical errors [errors made by professionals] and costs due to literacy

>related errors [errors made by patients]. I am very disquieted by the

>assumption that costs are due to patient error or to patient deficits.

>

>Rima

>

>Rima E. Rudd, ScD, MSPH

>Department of Society, Human Development & Health

>Harvard School of Public Health

>677 Huntington Avenue

>Boston MA 02115

>Phone: 617 432 1135

>fax:     617 432 3123

>web:    www.hsph.harvard.edu/healthliteracy

>www.hsph.harvard.edu/sisterstogether

>----------------------------------------------------

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>




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