There are many theories which serve as fundamental building blocks for practice in nursing. They often also serve as frameworks for research. One such theory is health literacy theory. The purpose of this paper is to present what health literacy theory is, review its use in a research-oriented article, evaluate its relevance or appropriateness to guide practice or research based on that article, and how I might apply this theory in your future advanced role.
Health literacy theory is a concept which stresses the idea that individuals should be “literate” in terms of skills that “maintain or improve health” (Hepburn, 2012, p. 230). Hepburn (2012) provides a comprehensive account of the skills which are included in the idea of health literacy: “cognitive (knowledge), behavioral (functional), advocatory (proactive), and existential (spiritual), and incorporates basic skills such as reading, writing and numeracy, and foster the ability to effectively analyze, communicate and question existing information in order to make sense of life with uncertainty and illness” (p. 230). Health literacy skills are a combination of basic and sophisticated elements which enable the individual to not only understand how to be health literate but also why one should be health literate.
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There are three levels of health literacy: level I or functional literacy, which is the “ability to apply basic health literacy skills, such as reading and understanding medication labels”; level II or interactive health literacy, which “involves use of cognitive skills and operate in a social environment supports social participation in health-related issues in the community”; and level III or critical literacy, which “incorporates the ability to evaluate health issues, determine the challenges and advantages of specific issues, recognize the potential benefit of a particular strategy, and offer advice at the community level” (Hepburn, 2012, p. 230). Health literacy necessitates that an individual have or develop the competence to understand health information and be proactive relative to health-related objectives (Hepburn, 2012). Hepburn (2012) goes on to state that it is in regard to health literacy where clinicians may fail – a clinician may not have the right or adequate expertise to address all levels.
The article selected for review is “Associations Between Older Adults’ Spoken Interactive Health Literacy and Selected Health Care and Health Communication Outcomes” by Rubin, Parmer, Freimuth, Kaley, & Okundaye (2011). Rubin et al. (2011) acknowledge that expanding and refined notions of health literacy mean that measures are needed in order to evaluate health literacy and its attendant features, including information-seeking behaviors. Their study uses an older adult population to examine the information exchange element of health literacy, its use in outcome prediction, health care satisfaction, and spoken health message comprehension (Rubin et al., 2011). The authors focused on several health literacy indices such as the short form of the Test of Functional Health Literacy in Adults (S-TOFLA), Medicare Beneficiary Survey (MCBS), and the Measure of Interactive Health Literacy (MIHL), to name a few. While their findings were interesting in terms of the relative effectiveness of such tools, the article had several limitations which call into question the universal applicability of their findings. For one, their population was, by their own admission, very narrow and specific: “low socioeconomic status older adults in one geographic region—no doubt displays different health literacy characteristics than do other populations” (Rubin et al., 2011, p. 200). The authors also admit challenges in terms of active listening in the patients, as well as acquiring spontaneous oral utterances of information-seeking (Rubin et al., 2011). Nevertheless, their ultimate conclusion is hard to disagree with: “Measuring aspects of patient-consumer interactions with health message sources simply aligns health literacy research with those conceptual foundations” (Rubin et al., 2011, p. 201).
The use of health information literacy as a driving factor in this study – in fact, as the driving factor in this study – and how it is evaluated provide an important framework for research. It’s not enough to emphasize the importance of being health literate; clinicians must determine if an individual is health literate and then determine at what level the individual is literate in order to interact with that individual in a way that is meaningful and comprehensible to the individual. Furthermore, this can guide the clinician’s efforts in assisting an individual to achieve higher levels of literacy if necessary (i.e., if the individual is only functioning at level I literacy). Rubin et al. (2011) sought to determine what measures were meaningful and how they might be used in the health literacy process. In short, their study used health literacy theory in a very meaningful way and clearly demonstrates its importance.
I can use their research because I have an interest in working in geriatrics who were represented in the specific population Rubin et al. (2011) studied. However, for a more universal approach, I would probably be more inclined to use the work of Squiers, Peinado, Berkman, Boudewyns, & McCormack (2012) which provides a complete health literacy framework, “the full pathway from development and moderators of health literacy skills, their application, and the outcomes” (p. 30). This article would serve me well in my interactions with patients because it would help me be more effective in patient education because it provided me with a better understanding of the full continuum of health literacy. It will be useful in guiding how I present information to patients and the ways I would encourage them to ask me or other healthcare providers for information. Since health literacy theory is about the ability of the patient to understand and seek behavior, it is important to me to make sure that my patients understand the information I communicate to them. It is also important that they be able to take responsibility for their own care as well, and part of that is being health literate.
- Hepburn, M. (2012). Health literacy, conceptual analysis for disease prevention. International
Journal Of Collaborative Research On Internal Medicine & Public Health (IJCRIMPH), (3), 228-238. - Rubin, D. L., Parmer, J., Freimuth, V., Kaley, T., & Okundaye, M. (2011). Associations between
older adults’ spoken interactive health literacy and selected health care and health communication outcomes. Journal Of Health Communication, 16191-204. doi:10.1080/10810730.2011.604380 - Squiers, L., Peinado, S., Berkman, N., Boudewyns, V., & McCormack, L. (2012). The health
literacy skills framework. Journal Of Health Communication, 1730-54. doi:10.1080/10810730.2012.713442
