Advancing Health Literacy Research

Abstract

We are pleased to present this special issue on health literacy of the Journal of Health Communication. The journal continues to demonstrate a deep commitment to this important topic, offering a venue to exhibit leading health literacy research for the third year in a row. We hope that this special issue helps guide the overall direction of the field and serves as a springboard for lively discussion, innovative research, and practice initiatives.

As in the past, this special issue includes findings presented at the Health Literacy Annual Research Conference (HARC III), which was held on October 17–18, 2011 in Chicago, Illinois and was attended by more than 200 health literacy investigators. The 2011 conference was unique, as it was co-located with the International Conference for Communication in Healthcare (ICCH), an event dedicated to presenting cutting-edge research and educational strategies to improve how information and ideas are exchanged in health care settings—topics that are clearly related to the health literacy agenda. The coordination of these two conferences allowed researchers from countries around the world to share findings and build collaborations for the future. In doing so, it offered an exceptional opportunity for HARC to fulfill its primary objectives of (a) professional development, (b) advancing the science of health literacy research, and (c) promoting interdisciplinary research. We look forward to continuing our pursuit of these goals during HARC IV, which will be held on October 22–23, 2012 in Bethesda, Maryland.

The expansion of HARC, along with the growth in health literacy research, has led to the largest health literacy special issue yet. This issue includes over 20 articles and commentaries from across the United States and Europe, covering a number of key themes. Recognizing the growing diversity of the United States, multiple articles explore the links between health literacy, culture, and language proficiency. This includes a commentary from McKee and Paasche-Orlow calling for greater collaboration between researchers studying low health literacy and those focusing on limited English proficiency, as well as a conceptual framework by Lie, Carter-Pokras, Braun, and Coleman that integrates the concepts of health literacy and cultural competence for the purpose of improving education for health care professionals. An original research article from Shaw, Armin, Torres, Orzech, and Vivian explores the relationship between culture, health literacy, and chronic disease self-management among patients from four ethnic groups, while another from Sentell and Braun examines health status by health literacy and English proficiency among an ethnically and linguistically diverse study sample.

There has been increased recognition by researchers, clinicians, and government agencies of the importance of promoting patient-centered care and considering patient preferences in the design and implementation of interventions. Three articles in this issue respond to this movement by describing patients’ preferences for receiving health information. Cawthon and colleagues discuss which components of their PILL-CVD intervention were considered beneficial according to patients, particularly those with low health literacy. Gaglio, Glasgow, and Bull report findings from an in-depth study on patients’ preferred sources of health information. Finally, Guise, Koonce, Storrow, Kusnoor, and Ye reveal the importance of personalizing health education interventions by patients’ preferred learning style and literacy skills.

As in the past, this special issue also includes articles focused on the conceptualization and measurement of health literacy. Squiers, Peinado, Berkman, Boudewyns, and McCormack introduce a conceptual framework for health literacy that builds on prior frameworks, but emphasizes a full pathway from the development of literacy skills to resulting health outcomes. Haun, Luther, Dodd, and Donaldson report on the conceptual and measurement variations between three commonly used measures of health literacy. Helitzer, Hollis, Sanders, and Roybal introduce the TALKDOC, an instrument designed to measure multiple health literacy competencies within the context of HPV and cervical cancer. Rubin presents an article on the construct of “listenability” (versus readability) as part of health literacy. Finally, Bann, McCormack, Berkman, and Squiers describe the validation of a shortened, 10-item version of their Health Literacy Skills Instrument. While development and validation activities for these tools should continue, next steps include incorporating these measures into future and ongoing research. This is essential to advance the field and ensure that validated, theory-based instruments are being used in practice.

This special issue expands upon the existing literature by including studies that further explore the association between health literacy and various health outcomes. Mitchell, Sadikova, Jack, and Paasche-Orlow assess the link between health literacy and re-hospitalization, while Mosher, Lund, Kripilani, and Kaboli examine the relationship between health literacy and medication-related outcomes, including medication knowledge, adherence, and adverse drug events. Arnold and colleagues assess the role of health literacy in colorectal cancer screening knowledge, beliefs, and experiences. From an international perspective, Sahm, Wolf, Curtis, and McCarthy consider the prevalence and potential effects of limited health literacy in Ireland. Together, these articles serve to identify areas where additional research is needed; such findings have the potential to inform the design and implementation of future interventions.

Three articles describe efforts to improve the design, content, and efficacy of written materials from a health literacy perspective. Boxell and colleagues present information on the development and testing of a gynecological cancer information pamphlet in the United Kingdom, while King et al. evaluate the benefit of using symbols on prescription medication information leaflets. Liu and Rawl examine the role of text cohesion on the understandability of print materials, and Kaphingst et al. describe the development and testing of the Health Literacy INDEX, a tool that measures the health literacy demands of written health information materials. These articles highlight the ways in which written information can be enhanced, but also show the limitations of using print material alone to convey health information to patients.

Finally, a few articles in this special issue address topics that are of particular salience to health care organizations and providers. Weaver, Wray, Zellin, Gautam, and Jupka describe a process of assessing organizational health literacy in health centers serving vulnerable populations. Jager and Wynia examine how often physicians ask patients to “teach-back” information provided during clinical encounters; this article specifically examines the sociodemographic characteristics of patients who receive this health literacy via best practice versus those who do not. Finally, Bickmore and Paasche-Orlow discuss the potential impact of health information technology on health disparities and caution that greater inequalities will result without significant advances in health information technologies that are usable and accessible for people with low health literacy. The study by Gazmararian, Yang, Elon, Graham, and Parker explores this concern by examining the role of health literacy on women's ability to enroll electronically in the Text4Baby intervention.

Overall, this special issue covers a variety of topics, methods and perspectives. It takes a truly interdisciplinary approach, incorporating research from public health, medicine, nursing, anthropology, and communication science, among others. It includes perspectives of insurers, clinicians, patients, and researchers from the United States and Europe, using quantitative and qualitative methodologies to examine some of the most pressing questions in health literacy research. This issue acknowledges the limitations of a still relatively new field, exhibits a continued discussion about the conceptualization of health literacy and the use of imperfect measures—yet also shows great promise and progress. To move forward, we must continue to engage in this interdisciplinary dialogue, confronting and addressing our challenges, with the ultimate objective of advancing this important discourse.