Why is health literacy crucial?


Health Literacy 101

It is very important to be healthy, but the more important thing is to know what it means to be healthy, to understand the experts on the subject. Diseases can occur in our bodies with different effects. Usually, people go to a doctor after these symptoms, and the doctors do various tests to understand the problem. According to the results, the person listens to the doctor what the problem is. This expression usually does not like “Symptoms show that you have benign tremor disease” and “therefore I plan to do DBS,” or “I have to do anastomosis and devascularization with the esophageal transaction”. However, the patient must have the basic knowledge to understand the problem. This is called health literacy in the literature.

What is Health Literacy?

Health literacy can be defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (1). This term was first used by Simonds (2). Patients are often exposed to complex and difficult to understand terms in the healthcare system. Limited health literacy increases the time the patient spends in the hospital and negatively affects the diagnosis and treatment process. Besides, the prolongation of this process brings additional burdens to the health system. Measuring this inadequacy is as important as preventing it. There are various tests for measurements. 4 of them stand out. These are TOFHLA (Test of Functional Health Literacy in Adults), REALM (Rapid Estimate of Adult Literacy in Medicine), HALS (Health Activities Literacy Scale), NVS (Newest Vital Sign) (3).

Health Literacy Tests

Test of Functional Health Literacy in Adults (TOFHLA): This test has been developed using real hospital materials. Its application takes 22 minutes. In the test development process, experts examined forms such as patient education material, prescription bottle labels, patient registration forms. The test was developed on these materials. It consists of 2 parts: reading comprehension and mathematics. Results from these sections have equal solids and give a score between 0 and 100.

Rapid Estimate of Adult Literacy in Medicine (REALM): The Rapid Estimate of Adult Literacy in Medicine (REALM) is a screening tool in which an adult patient is tested for common medical words for body parts and diseases. The patient gets a score between 0-66.

REALM Evaluation Metrics
Score Category Result
0-183rd   grade & BelowVery Low literacy will not be able to read most material.
19-444th grade & 6th gradeLow literacy may not be able to read prescription labels.
45-607th grade & 8th gradeAverage literacy, most patients may have problems with educational material.
61-66High SchoolMost patients will be able to read the educational material.

Health Activities Literacy Scale (HALS): It is a scale that ranks health literacy skills from low to high on a scale of 0-500 (4). Evaluates 5 different activities. Health promotion, health protection, disease prevention, Health care, and maintenance, and System navigation. Although HALS does extensive measurements, it has 191 questions and it can take hours to solve. Therefore, it is not easy to use in research (5).

Newest Vital Sign (NVS):  It can be done in English and Spanish. It is advantageous in terms of fast and easy applicability. It only takes 3 minutes. Researchers use this tool to measure health literacy and assess the impact of low health literacy on diverse health outcomes (6).

How to develop health literacy?

The Health Literacy Pathway Model was developed in the study conducted by Edwards et al (5). People develop more in health literacy after each stage. This pathway is shown in figure 1.

The Health Literacy Pathway Model (5)

Stage of health information creation: This stage represents the knowledge a person has about their general health and their own health problems. This information is generated through interactions with healthcare professionals or educators, discussions between friends and family, and information from the media.

Stage of developing health literacy skills: This stage represents competencies in seeking and using information, listening, problem-solving, and decision making. Examples include taking medication and performing blood glucose measurements on their own.

Stage of displaying health literacy actions: It is the process through which a person conveys his / her treatment and service request, concerns, and requests regarding the issue. It includes communication with healthcare professionals and contributes to the consultation.

Stage of post-informing decision-making: Some patients may offer some treatment options to the doctor after discussing with their family along with the treatments recommended by their healthcare professionals.

Stage of conscious decision-making: At this stage, options are produced, discussed, and final decisions are made about the treatment. People who reach this stage are from the first stage to the fifth stage.

  1. Health Literacy: A Prescription to End Confusion
  2. Health Education as Social Policy
  3. What is Health Literacy? How to Measure It? Why is It Important?
  4. Literacy and Health in America
  5. The development of health literacy in patients with a long-term health condition: the health literacy pathway model
  6. The Newest Vital Sign