Berkman, Nancy D., Terry C. Davis and Lauren McCormack. “Health Literacy: What Is It?” Journal of Health Communication, 15.S2 (2010): 9-19.
The authors start with an examination of the history of measuring literacy in the United States. Interestingly, this shows that the level of ability involved in the definition of literacy used in measurements has increased over time. (For example, up through the 1930s, literacy was simply considered the ability to read and write in any language. But by the 1905s, functional literacy was considered as having at least a 6th grade education, and today people are often expected to have postsecondary training in order to get jobs.) Although studies have shown that illiteracy is declining, many adults still function with very low literacy levels. Widely cited surveys of adult Americans in the 1990s which looked at literacy as a set of skills with three domains (prose, document, quantitative skills) found that 21-23% of the population was in the lowest of the 5 literacy levels, with 25-28% in the second lowest. However, it was not until 2003 that a large scale assessment included questions on health literacy (National Assessment of Adult Literacy Survey (NAAL) asked questions involving clinical, preventive, and navigation of the health care system).
The article notes that there is not really a consensus on what health literacy means, but rather many separate definitions. For their own use, the authors modify a widely used definition of health literacy: “the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions” They then provides a discussion of all the different components which make up the warring definitions. Firstly, is health literacy an individual-based or broader construct? They conclude that it is generally targeted at the individual – aimed at a single person’s ability or capacity. How does the health care system influence the definition of health literacy? They find that while health literacy definitions should take into account technology and the society overall, they shouldn’t overdo it. Finally is health literacy static or dynamic? They think that it is dynamic, growing as individuals encounter new situations. Overall, however, the authors conclude that there is no one right definition of health literacy. Since this variety reflects the complexity of the field, researchers should choose the definitions which fits their needs.
This was a very useful article for the student or professional just coming to the subject of health literacy. I found it to be thoroughly researched and quite well done.