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.

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Clinical trials are essential for developing new and effective treatments and improving patient quality of life; however, many trials cannot answer their primary research questions because they fall short of their recruitment goals. This article reports the results of formative research conducted in two populations, the public and primary care physicians, to identify messages that may raise awareness and increase interest in clinical trials and be used in a national communication campaign. Results suggested that participants were primarily motivated to participate in clinical trials out of a self-interest to help themselves first. Messages illustrated that current treatments were tested via clinical trials, helped normalize trials as routine practices, and reduced concerns over trying something new first. Participants wanted messages that portray trials as state-of-the-art choices that offer some hope, show people like themselves, and are described in a clear, concise manner with actionable steps for them to take. The study revealed some differences in message salience, with healthy audiences exhibiting lower levels of interest. Our results suggest that targeted messages are needed, and that communication with primary health-care providers is an important and necessary component in raising patient awareness of the importance of clinical trials.

Health communication, health education, and health literacy are rooted in a common understanding of human communication and share the goals of enhancing human health, improving health outcomes, and reducing health disparities. We have an opportunity to mobilize the wisdom, research, and practice of these disciplines to collaborate and foster new research and understanding. Using this perspective, we note the common framework of meaning-centered communication within health communication, health education, and health literacy and suggest it provides a conceptual foundation to advance multidisciplinary understanding and collaboration. We urge health communication, health education, and health literacy professionals to reach out across the boundaries of their respective disciplines to transform health communication practices and research.

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The fi rst skill of a great translator is humbleness, to be a servant. Once you are a servant, you may be lucky to be called a master of your craft. And, you need the humbleness to understand your original, to be part of it-then also the practical humbleness to get someone who knows more than you to check your work. That collaboration is very enriching and very rewarding-a good way of ensuring you produce a decent translation." -Marco Sonzogni, n.d.

The unique circumstances surrounding Zika, including the fact that it is both mosquito-borne and sexually transmissible, brought to the fore concerns about optimal ways to communicate risk in an environment characterized by rapidly evolving knowledge. The difficulty in doing so is magnified by the fact that science-based health messages from governmental agencies must be developed in an evidence-based, audience-participative, and collaborative manner. A recent reminder in JAMA asserted the importance of preparing now for future threats. Understanding how the knowledge and messaging about Zika changed across time should help public health officials prepare for such challenges.

The fi rst skill of a great translator is humbleness, to be a servant. Once you are a servant, you may be lucky to be called a master of your craft. And, you need the humbleness to understand your original, to be part of it-then also the practical humbleness to get someone who knows more than you to check your work. That collaboration is very enriching and very rewarding-a good way of ensuring you produce a decent translation." -Marco Sonzogni, n.d.