Health literacy measurement: embracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice

Abstract

Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement is important for global health because diverse stakeholders, including the WHO, use these data to inform health practice and policy, and to understand sources of inequity. In this Practice paper, we explore the potential for negative consequences, bias and epistemic injustice to occur when health literacy instruments are used across settings without due regard for the lived experiences of people in various contexts from whom data are collected. A health literacy measurement approach that is emic-sensitive, strengths based and solution oriented is needed to minimise biased data interpretation and use and to avoid epistemic injustice.

Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS19-Q12 Instrument in Seventeen Countries

“…There are also indications for potential improvements of the instrument. Following the shift in measurement theory and practice [ 85 ], the HLS 19 -Q12 instrument must be validated again, when used in further studies and samples.…”

Perceptions of health and coping strategies among temporary migrant workers in East and Southeast Asia: a systematic review

“…The importance of agency in terms of health and coping strategies highlighted in this systematic review underscores the need to include migrant workers in the development and delivery of health promotion activities. As noted in recent commentary [ 50 ], an inclusive and positive approach can optimise the benefits of “strength-based and solution-oriented” approaches towards health as well as contextualising specific issues (p. 5). Osborne et al [ 50 ] argued that deficit-based models draw attention to what people do not do or lack in terms of skills and knowledge.…”

“…As noted in recent commentary [ 50 ], an inclusive and positive approach can optimise the benefits of “strength-based and solution-oriented” approaches towards health as well as contextualising specific issues (p. 5). Osborne et al [ 50 ] argued that deficit-based models draw attention to what people do not do or lack in terms of skills and knowledge. Such approaches risk increasing marginalization and stigma for certain groups and may elide the complexity associated with contexts such as those created by temporary migration.…”

From Project-Based Health Literacy Data and Measurement to an Integrated System of Analytics and Insights: Enhancing Data-Driven Value Creation in Health-Literate Organizations

“…Second, while advancing health literacy data generation from measurement to integrated monitoring mechanisms, it is recommended to lean on local contexts and participatory approaches that are strengths-based and solution-driven to promote health and equity [ 26 ]. The implementation of data analytics and predictions would not only inform and serve policy, research and practice in the organizations, but also promote the implementation of new tools and interventions to change the level of health literacy in an organization, community or setting.…”

“…Third, health literacy is a multi-dimensional concept that is content- and context-specific [ 26 ]. The tools to measure health literacy will, therefore, depend on the health literacy challenge that is explored and which aspects of health literacy are in focus as well the implications of the target group being researched.…”