Thursday, June 23, 2011

Heading home

Flying home last week, via an unexpected and unwelcome detour to Sydney, I started to wonder how I might go about communicating the massive amount of information I have gathered. Health literacy is a poorly conceived notion in many ways. There are many definitions - all involving abilities and capacities to access, understand, communicate, use and evaluate health information. But the jury is very much out on what it is about health that is so tricky to access, understand, communicate, use and evaluate. Why is it that some people are able to manage relatively well? Is it cognitive ability, education levels, socio-economic status - empowerment, confidence? Or is it an increasingly complex health care system, together with an increase in chronic disease and the necessity for people to manage their own health. Is it a bit of all of those things? At the Health Literacy UK conference that I attended in Manchester, Don Nutbeam (health literacy guru in the UK) pointed out that the broader notion of literacy has struggled for a theory and measurement for many decades. So we needn't panic. The debate will continue and theories and measurements will come and go but in the meantime we need to apply what we do know and in doing so we need to feed the development of those theories and measurements.
So how do we act? What do we put in place to cover all possible reasons for why health literacy might be an issue. Actually, there are some very good starting points - the Calgary Charter, the American National Action Plan, the plain language movement (yes, I know, It's a start but not enough). Rima Rudd's work on health literate environments and the many, many interventions that encourage better communication from health professionals and better access for people who, for whatever reason, have been disconnected from health. As health professionals we do have a role to encourage what Christina Zarcadoolis refers to as generative health literacy - applying information to new or novel situations. And that requires a new understanding of how we all work as patients. How, as patients, we access, understand, use, communicate and evaluate information. And that's hard, because we all do it differently. It's hard but necessary.

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