BackgroundInterest in and debates around health literacy have grown over the last two decades and key to the discussions has been the distinction made between basic functional health literacy, communicative/interactive health literacy and critical health literacy. Of these, critical health literacy is the least well developed and differing interpretations of its constituents and relevance exist. The aim of this study is to rigorously analyse the concept of critical health literacy in order to offer some clarity of definition upon which appropriate theory, well grounded practice and potential measurement tools can be based.MethodThe study uses a theoretical and colloquial evolutionary concept analysis method to systematically identify the features associated with this concept. A unique characteristic of this method is that it practically combines an analysis of the literature with in depth interviews undertaken with practitioners and policy makers who have an interest in the field. The study also analyses how the concept is understood across the contexts of time, place, discipline and use by health professionals, policy makers and academics.ResultsFindings revealed a distinct set of characteristics of advanced personal skills, health knowledge, information skills, effective interaction between service providers and users, informed decision making and empowerment including political action as key features of critical health literacy. The potential consequences of critical health literacy identified are in improving health outcomes, creating more effective use of health services and reducing inequalities in health thus demonstrating the relevance of this concept to public health and health promotion.ConclusionsWhile critical health literacy is shown to be a unique concept, there remain significant contextual variations in understanding particularly between academics, practitioners and policy makers. Key attributes presented as part of this concept when it was first introduced in the literature, particularly those around empowerment, social and political action and the existence of the concept at both an individual and population level, have been lost in more recent representations. This has resulted in critical health literacy becoming restricted to a higher order cognitive individual skill rather than a driver for political and social change. The paper argues that in order to retain the uniqueness and usefulness of the concept in practice efforts should be made to avoid this dilution of meaning.
BackgroundLow health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health. AimTo assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population skills in relation to these. Design and settingAn English observational study comparing health materials with national working-age population skills.
This review seeks to determine the prevalence of correctable visual impairment (VI) in older people in the UK, to discover what proportion of these cases are undetected, to suggest reasons for the poor detection and to make recommendations for improving the detection. To establish the context of these issues, the review will also touch on the general prevalence and causes of VI in older people in developed countries and on the impact of VI in older people. Typically, studies suggest that VI affects about 10% of people aged 65-75, and 20% of those aged 75 or older. There is a strong relationship between impaired vision in older people and both reduced quality of life and increased risk of accidents, particularly falls. The literature suggests that those with low vision are about two times more likely to have falls than fully sighted people, and the annual UK cost of treating falls directly attributable to VI is £128 million. The literature on the prevalence of undetected reduced vision in older people reveals that between 20 and 50% of older people have undetected reduced vision. The majority of these people have correctable visual problems (refractive errors or cataract). It is particularly startling that, in Ôdeveloped countriesÕ, between 7 and 34% of older people have VI that could simply be cured by appropriate spectacles. The reasons why so many cases of treatable VI remain untreated are discussed, and suggestions are made for improving the detection of these cases. We conclude that there should be better publicity encouraging older people to attend for regular optometric eye examinations. A complementary approach is annual visual screening of the elderly, possibly as part of GPs annual health check on people aged 75 years and older. Recommendations are made for evaluating new approaches to screening and for improving the management of cases detected by screening.Keywords: cataract, correctable visual impairment, low vision, older people, refractive error Objectives and methodology of reviewThe focus of this review is to answer the following primary questions: ÔWhat is the prevalence of correctable visual impairment (VI) in older people in the UK?Õ and ÔWhat proportion of these cases are undetected?Õ (Table 1). Although the review concentrates on UK studies, some particularly pertinent studies from other developed countries have been included.In addition, we sought information on some secondary questions. To provide context for the primary questions, major population-based epidemiological studies evaluating the prevalence of VI in developed countries are reviewed to answer the secondary questions ÔWhat is the prevalence and what are the main causes of VI in developed countriesÕ. These studies also allowed a comment on the effect of age on VI. To determine the impact of VI, the secondary question ÔWhat are the major consequences of VI in older people?Õ is also investigated, concentrating on quality of life, depression, and falls.Two further secondary questions, ÔWhy are cases of treatable VI in older ...
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