Literacy and Learning in Health Care: FIGURE 1

Abstract

The relationship between literacy and health outcomes are well documented in adult medicine, yet specific causal pathways are not entirely clear. Despite an incomplete understanding of the problem, numerous interventions have already been implemented with variable success. Many of the earlier strategies assumed the problem to originate from reading difficulties only. Given the timely need for more effective interventions, it is of increasing importance to reconsider the meaning of health literacy in order to advance our conceptual understanding of the problem and how best to respond. One potentially effective approach might involve recognizing the known associations between a larger set of cognitive and psychosocial abilities with functional literacy skills. We review the current health literacy definition and literature and draw upon relevant research from the fields of education, cognitive science, and psychology. In this framework, a research agenda is proposed that considers an individual's health learning capacity, referring to the broad constellation of cognitive and psychosocial skills patients or family members must draw upon to effectively promote, protect, and manage their own or a child's health. This new, related concept will ideally lead to more effective ways of thinking about health literacy interventions, including the design of health education materials, instructional strategies, and the delivery of healthcare services to support patients and families across the lifespan.

Literacy, Cognitive Function, and Health: Results of the LitCog Study

“…27 Our findings affirm the need to help patients build appropriate background knowledge and skills, but to also reduce the cognitive demands of health systems through unnecessarily complex health tasks. As a start, health literacy interventions should move beyond plain language approaches and deconstruct the tasks required of patients within a particular healthcare context.…”

“…23 In fact, there is a small but growing body of literature documenting associations between measures of literacy, health literacy, and limited sets of cognitive abilities. 15,[24][25][26][27] These studies support the premise that the impact of health literacy on outcomes might be explained by a wide array of cognitive domains. It is imperative to explore these links, as this will expand our thinking on the true nature of the problem, and improve our ability to develop more effective strategies for identifying and responding to individuals who will struggle to learn and apply health information.…”

“…61 A modified perspective of health literacy that includes an expansive view of cognitive skills necessary to manage health could also inform the development of more precise clinical assessments to identify those at risk. 12 Despite calls for clinicians to follow universal precautions and assume all patients may have health literacy concerns, remediating inadequate cognitive skills for self-care might require clinical screening. This would then allow a greater allocation of resources, in terms of education and followup, to those struggling to learn and apply health information and instructions.…”

“…12 A global set of cognitive skills are necessary to access health services, process and comprehend text and numerical information, orally express oneself, understand and recall spoken instructions, make inferences, utilize technology, critically weigh options and make decisions, and sustain often complex behaviors. Several studies over the past two decades allude to this, as they have reported strong associations between a broader set of cognitive abilities and the aforementioned health outcomes associated with literacy skills.…”

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

“…Evidence from cognitive psychology suggests that this reduces the cognitive burden of information by enabling participants to 'chunk' information and retain more in short-term memory. 135,136 This is particularly important for people with poor basic skills owing to the strong association between health literacy and cognitive ability. 137 Importantly, reducing the cognitive burden of information can increase subsequent recall and this is apparent for all health literacy groups.…”