Health Literacy Research: Looking Forward

We are pleased to present this special issue on Health Literacy of the Journal of Health Communication. This marks the second year in a row that the Journal has published a special issue on this topic, demonstrating its ongoing commitment to field of health literacy. The articles in this special issue help to nudge the field forward, illustrating some important advances and future directions, while acknowledging ongoing challenges.

As with the inaugural version, this issue presents findings from the prior year's Health Literacy Annual Research Conference (HARC) which took place in October 2010 in Washington DC. The number of abstract submissions and meeting attendees increased by 20% relative to the first year, reflecting the growing interest of those from diverse disciplines. The goals of HARC include: (1) professional development, (2) advancing the science of health literacy research, and (3) promotion of interdisciplinary research. We aim to create a venue that can help attract young investigators and new ideas and methods to the field. We aim to promote the discourse in this field of inquiry especially regarding core definitional issues, health disparities, and health quality. The varied nature of the research that is relevant to the problem of health literacy makes an interdisciplinary conference incredibly important; bringing such a group of researchers together provides the milieu for new admixtures, new collaborations, and further creativity. A marker of the success we are having in expanding the field towards this goal is that more than half of the presentations at HARC II represented the work of non-MD PhD investigators from a wide array of disciplines. We are hoping for continued growth for HARC III, which will take place October 17–18 in Chicago and will be held in coordination with the International Conference on Communication in Healthcare (ICCH). We hope to see you there (http://www.bumc.bu.edu/healthliteracyconference/)!

In their Commentary, Pleasant et al., describe a research agenda that includes building a new comprehensive approach to the measurement of health literacy and why this is an important task facing health literacy research and practice. Their call for linking health literacy measurement to theory relates to the Commentary by Johnson et al., which is a call to regain a focus on basic research as the basis for effective interventions. It is quite useful to read these Commentaries in concert with a review of the current status of health literacy intervention research. In fact, we include two papers that review health literacy interventions (Sheridan et al. and Allen et al.) as they represent very different approaches to the review and appraisal of the current health literacy intervention literature.

One study underway tests intervention strategies that help educate patients and improve self-care skills in the area of hypertension (Baker et al.). This is one of the few studies to use a randomized control trial study design and look at clinical outcomes. Kandula and colleagues are using an experimental approach to test the effectiveness of teaching strategies to improve patients' recall and retention of information about diabetes management. Other strategies are considered for increasing health literacy including a wellness curriculum for low-income youth (Diamond et al.) and through adult education programs (Freedman et al.).

Several authors share ongoing work in health literacy measurement and methodology (Fransen et al.), including technology-based data collection approaches (Hahn et al.) and how health literacy can affect health care interactions (Manganello et al. and Martin et al.). Rubin and colleagues look at the association between older adults' spoken interactive health literacy and health care experiences among a low-income population. This paper and the paper by Pizur-Barnekow et al. illustrate the practical challenges of measuring interactive health literacy, which is the least studied of all health literacy components. Chin et al. investigate multiple paths to health literacy by exploring the effects of selected cognitive elements in an elderly cohort for two of the most commonly used measures of literacy, while An et al. examine the comprehension of direct to consumer advertising in an elderly cohort.

This special issue examines health literacy as a risk factor for misuse of medication (Shone et al.) and the relationship between health literacy and various intermediate health outcomes including adherence to medications (Osborn et al.). Sentell et al. present the first population-based examination of the prevalence and associations of health literacy in a Hawaiian sample. Macabasco-O'Connell and Fry-Bowers describe the knowledge and perception of health literacy among nursing professionals. Hardie et al. demonstrate the relationship between health literacy, health services utilization and cost for members of a health plan. This article along with an accompanying editorial by Rush and Paasche-Orlow promote the expansion of health literacy interventions into larger operational settings. A European perspective on how this can happen is presented by Sørensen and Brand.

The papers included in this special issue clearly represent a wide variety of methods and perspectives. Some of the variability represents logical differences that inherently emerge from the research questions; however, it appears that some of the variability represents underlying conceptual disagreements about health literacy. To a certain extent, we, as the editors of this volume, tried not to impose our views. By and large, we tried to allow authors to express themselves. Yet, the process has reinforced our view that the field could greatly benefit from clarity and consensus. Disagreements will likely persist, but they should represent the well examined views of an intellectually curious and vibrant health literacy research community.

Acknowledgments

This supplement is supported by the following: National Institute on Minority Health and Health Disparities (NIMHD; grant # 2 R13 MD003392-03); Agency for Healthcare Research and Quality (AHRQ); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); National Institute of Biomedical Imaging and Bioengineering (NBIB); Section of General Internal Medicine, Boston University Medical Center; OptumHealth; RTI International; and Health Literacy & Learning Program (HeLP), Northwestern University.