Health Literacy Studies

This website was originally developed in the 1990s through the HSPH Health Literacy Studies, at the Harvard T.H. Chan School of Public Health, with Dr. Rima Rudd as Principal Investigator. It was the first academic site to provide resources, study findings, policy developments, and links in the burgeoning area of health literacy inquiry. Health literacy is now considered an important variable for analyses of health outcomes and a mediating factor in health disparities. Research findings provide insights for the design and development of health materials, for professional education and practice, for institutional change, and for policy initiatives. We hope you enjoy, use, and share the resources.

Transition: Dr. Rudd is now retired as Emerita in the Department of Social and Behavioral Sciences and this site will be archived at HSPH (available on request). At the same time, all existing tools and content as well as updates and additions are transitioning, through the efforts of Dr. Cynthia Baur (Endowed Professor and Director of the Horowitz Center for Health Literacy at the University of Maryland School of Public Health) to a special section of the Horowitz Center Center for Health Literacy Website. Thus, material from this site will be readily available at: (https://sph.umd.edu/research-impact/research-centers/horowitz-center-health-literacy).

In addition, Dr. Aya Goto (Professor of Practice and Director of the Takemi Program in International Health in the Department of Global Health at the Harvard T.H. Chan School of Public Health) seeks to make all content from this website available for dissemination and teaching purposes. Dr. Goto is designing a section of the Takemi Program website for international health literacy postings, updates, and discussions  (https://www.hsph.harvard.edu/takemi). Dr. Goto will share health literacy tools, post her health literacy research and workshops, and update health literacy efforts in Japan, Viet Nam, Brazil, and elsewhere. The content from this site, captured in full, will serve as a resource.

Overview

Health Literacy is a Complex Variable

Literacy is malleable. Certainly, one can learn and improve literacy skills. At the same time, literacy skills should not be considered in isolation. A measure of one’s literacy skills can vary, for example, based on the complexity of the text, the communication skills of the speaker, and/or environmental distractors. Consequently, literacy should not be considered or measured as a characteristic of an individual alone.

Literacy is dependent on the interaction between a reader and a text or between a speaker and a listener. Poor or complex writing will influence any measure of reading skills. A good listener might still struggle when the speaker is erratic or poorly organized. In addition, literacy is also  influenced by the context within which activities take place. Background noise, for example, can be distracting. Illness or fear can influence one’s ability to apply existing skills. Institutional characteristics can be intimidating or limiting. Consequently,  we must broaden our concept of  health literacy.

Health literacy is complex and is dependent on a number of key factors:

• Literacy skills of individuals – the ability to read, write, speak, listen, calculate, problem solve, use current technology.

• Communication skills of health professionals – the ability to present clear health information and data in talk and/or in written format; the skill to explain in everyday words, the ability to check for clarity and comprehension.

• Health texts: the written word in print or on-line, the spoken word in person or over the air waves, the various data displays [such as charts, graphs and diagrams] -with attention to vocabulary, the use of numbers and numeric concepts, organization, design, voice and tone.

• Tasks: the activities people are expected to do as they use the text [proximal tasks] and the activities people are expected to engage in after using the text [distal tasks].

• Context: the environment within which health activities take place – with attention to institutional characteristics, norms, practices, and policies and to broader systemic issues.

To get a true picture of how health literacy influences health related decisions, activities, and outcomes – we must consider all of these factors and develop measures for each of them. The early emphasis on the skills or abilities of individuals is being replaced by an understanding that a variety of key components of the literacy exchange shape the concept of health literacy and likely contribute to health outcomes.

Click on the sub-pages below for additional discussion and resources:

Definition of Terms

Deconstructing Health Activities

Slide Presentation by Rima Rudd

“This is Bad Enough” by Elspeth Murray