There are numerous different ways to quantify health literacy. Until recently, measures looked almost exclusively at the skills/deficits of the individuals, and not the deficits in terms of our health care systems.
Health literacy was mostly assessed through measuring reading ability, comprehension and word recognition skills. Some of the best known assessments include Rapid Estimate of Adult Literacy in Medicine (REALM) and the Test of Functional Health Literacy in Adults (TOFHLA).
More recently Professor Richard Osborne has led the development of the Health Literacy Questionnaire, based on the question ‘Thinking about your experiences in trying to look after your health (or the health of your family), what abilities does a person need to have to be able to get and to use all of the information they need?’
This led to the development of a series of statements, which can be used to understand the level of health literacy within a given population. The statements which were extensively researched, demonstrate clearly how health literacy needs extend beyond the ability to read and comprehend health information:
- Feeling understood and supported by healthcare providers
- Having sufficient information to manage my health
- Actively managing my health
- Social support for health
- Appraisal of health information
- Ability to actively engage with healthcare providers
- Navigating the healthcare system
- Ability to find good health information
- Understand health information well enough to know what to do
These statements clearly highlight the role of health professionals, services and organisations in adapting their practice to provide flexible and appropriate support to people with varying levels of health literacy.
Once health literacy within a local population is understood, organisations can move on to understanding how they might best respond. Current examples of response frameworks are:
- The Ophelia process (OPtimising Health LIterAcy) is designed to use health literacy profiling and community engagement to create a framework to respond to the health literacy needs of a local population.
- The Primary Care Health Literacy Assessment, developed by the Agency for Healthcare Research and Quality in America, is designed to help primary care practices assess how well they are responding to the health literacy needs of their population, but it is readily transferrable to other health settings.