The field of health literacy has evolved over the decades. While early work focused on individual skills (and deficits) and specific products (brochures and documents, for example), we, the authors, have come to a greater appreciation that health literacy is multidimensional-it includes both system demands and complexities as well as the skills and abilities of individuals. The individuals may be patients or family members, and the providers of information may be health care providers, protocol developers, insurance organizations, pharmaceutical companies, and others. To personalize and attach the study of health literacy to a variety of disciplines, various experts have come up with such terms as "oral health literacy" and "environmental health literacy," which help to connect specific content to the central concept. But we believe it is important to generate a renewed and focused discussion about the definition of health literacy to ensure that the definition actually reflects today's understanding of health literacy as multidimensional. Furthermore, health literacy operates in a wide variety of settings and mediums. So, we believe a definition should include a description of this multidimensionality; an explanation of a variety of settings and modes and media; and the unique psychological impact of health literacy on empowerment and health decisions. It should also be tangible, and, finally, it should be testable. In this paper we present an argument for why the field of health literacy needs to come to a new level of consensus on the components of a definition of health literacy. Our goals are to contribute to increasing the effectiveness of the field of health literacy in preventing disease, eliminating health inequity, increasing treatment and medical care diagnosis and effectiveness, lowering barriers to access, and improving health outcomes at a lower cost overall. LIMITATIONS OF CURRENT DEFINITIONS The most obvious complication with having multiple and often conflicting definitions of health literacy may be the simple confusion to researchers, health and health care practitioners, and policy makers who need to process and select among the many options-a complex literacy task in and of itself. This is a particular challenge in that definitions of health literacy vary significantly. To date, what appears to be the most cited definition in the United States is that originally put forth by Ratzan and Parker in 2000-"The capacity of individuals to obtain, process, and understand basic health information and services needed to make appropriate health decisions"-which was then picked up by the U.
Objectives Women, the elderly, racial/ethnic, and rural populations are underrepresented in research, which leads to findings that are not representative of diverse populations. A “Sentinel Network” of five sites has been implemented to understand health concerns of underrepresented groups, based on the Community Health Worker (CHW) model. Methods Investigators at the five sites (Washington University, U.C. Davis, U. Michigan, U. Rochester, Einstein College of Medicine) and two community-focused national organizations (Community-Campus Partnerships for Health and Patient Advocates in Research), developed a common assessment used by CHWs to elicit information about research perceptions, top health and neighborhood concerns, and health conditions. Results CHWs surveyed 5,979 individuals. Across all sites, while the top five health concerns were hypertension, diabetes, cancer, weight, and heart problems, high blood pressure was the most common self-reported condition. Interest in research participation ranged from 70.1% among those of “other” races to 91.0% among African-Americans. Overall, African Americans were more likely than persons of other race/ethnic groups to be interested in participating in studies that required giving blood samples (82.6%), genetic samples (76.9%), medical records (77.2%), staying overnight in a hospital (70.5%) and using medical equipment (75.4%). Conclusions This study found that 87% of Sentinel Network participants are interested in participating in health research. Top health concerns were consistent across geography. African-Americans reported higher willingness to participate in research even if it requires blood samples or genetic testing.
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