Health Psychology – Chapter 14: Health Literacy
one way to influence healthrelated behaviour
dissemination of health information through communication has been one of the
most prominent approachs to health promotion over the past decades
to promote health, individuals should be provided with sufficient information that
will encourage them to make ‘healthy’ choices and to modify certain behaviours
that are considered ‘hazardous.’
this approach to health promotion acknowledges the relevance of human agency,
autonomy and personal choice in determining one’s health status and treats
individuals as active processors of data rather than passive responders to
Social Cognition Model: designed by psychologists who argue that knowledge,
perceived social norms, beliefs, attitudes and selfefficacy are associated with
behavioural intentions and behaviour itself. (ALL CHAPTER 6 MODELS
Interventions that have relied primarily on health information dissemination have
often FAILED to achieve sustainable behaviour change and have made little
impact in helping to narrow the gap in social and economic inequalities in health.
Just because individuals are given information about health doesn’t mean that
they will simply adopt the information given, understand it, or even read it in the
o Information dissemination is not enough as far as health promotion is
concerened because it is based on the assumption that knowledge alone is
sufficient to influence healthrelated behaviours and health outcomes.
o It assumes that individuals have equal access to information and that the
information disseminated is at a level understood by its intended
o Assumes that knowledge can lead to attitude change, can lead to
behavioural intentions, which then can lead to behaviour change itself.
o These assumptions are still unsupported
It is worth considering whether: 1) the INFORMATION reaches and is
understood by its intended recipients; 2) the RECIPIENTS have the necessary
skills to adopt the information; and 3) the ENVIORNMENTAL and
STRUCTURAL conditions are supportive of the behaviours advocated. THIS is
where health literacy comes in.
Early definitions of health literacy focused on the application of cognitive skills
such as reading and numeracy skills to understand and use information to function
in the healthcare setting.
Later, definitions expanded the concept to include social skills, and applying these
skills to include one’s ability to access information to promote and maintain
health. More RECENT definitions are incorporating ideas from health promotion
and empowerment to include evaluation and communication skills that can enable
individuals to improve their health by making informed decisions, increasing
control and taking responsibility for health in various contexts.
THREE LEVELS of health literacy (NUTBEAM, 2000) o Level 1: Functional Health Literacy ▯refers to the basic reading and
writing skills that can help individuals to function effectively in the health
care context. Directed towards improving knowledge
o Level 2: Interactive Health Literacy ▯refers to the development of
personal skills in a supportive environment to improve personal capacity
to enable individuals to act independently based on knowledge. Improving
motivation and selfconfidence to act on the advice received
o Level 3: Critical Health Literacy ▯refers to the ability to critically evaluate
and use information to actively participate in health promotion.
Zarcadoolas, Pleasant and Greer (2005) proposed a multidimensional framework
for understanding health literacy which organized the concept into four central
o Domain 1: Fundamental Literacy ▯refers to reading, writing, speaking and
o Domain 2: Scientific Literacy ▯refers to competence with fundamental
scientific concepts, comprehension of technological complexity, scientific
uncertainty, and an understanding that rapid change in the accepted
science is possible
o Domain 2: Civic Literacy ▯refers to skills that enable people to become
aware of public issues and to become involved in the decisionmaking
o Domain 4: Cultural Literacy ▯refers to the ability to recognize and use
collective beliefs, customs, worldview and social identity in order to
interpret and act on health information
Two of the most commonly used tools to assess health literacy levels of patients
in clinical practice that are the Rapid Estimate of Adult Literacy in Medicine &
the Test of Functional Health Literacy in Adults.
Health Promotion ▯the process of enabling people to increase control over, and to
improve, their health.
DeWalt, Berkman, Sheridan, Lohr and Pignone (2004) showed that patients with
low literacy tend to have poorer health outcomes, including knowledge,