Considerations for a New Definition of Health Literacy

Abstract

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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Seeking an expanded, multidimensional conceptual approach to health literacy and health disparities research

“…A recent NAM perspective explains while it is difficult to reach a consensus definition of health literacy, the perspective outlines some of the underlying issues that need to be resolved in order to achieve a consensus definition [88].…”

The future of safety science is happening now: The modernization of the benefit‐risk paradigm

“…A cognitive behavioral approach shifts patient engagement from a best practice to an expected standard and creates an integrated model focusing on producing usable tools that facilitate patients' and providers' understanding of risks, benefits, and required actions for safe and effective product use. [3][4][5]15 Through questionnaire design and development (eg, patient-reported outcomes), patient advocacy group interactions, and patient-centered data sources, safety sciences is positioned to advance the patient perspective throughout the entire product development life cycle. The use of terms like patient engagement and patient centeredness are now ubiquitous throughout health care, and increased focus on the patient's experience is driving patientcentered guidance for benefit-risk and the safe use of new drugs.…”

“…The future of safety science is monitoring risk throughout the drug development cycle to inform benefit‐risk management. An intelligently resourced and high‐functioning safety sciences organization not only enables risk management but also prescribing guidance, continuous safety monitoring, and identification of target patient populations, such that benefit‐risk for a product is optimized . The following sections explore the 3 building blocks of safety science in the context of optimizing benefit‐risk profiles and risk management.…”

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