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Measuring Health Literacy by its Consequences

Let’s welcome the new year with some new thinking about measuring health literacy.
 
It’s hard to say exactly what electricity is, but if the lights are on, we know we’ve got it. And we measure electricity by the light it produces. So it is with health literacy. It is hard to say just what health literacy is, but we know it by its consequences, and we can measure those consequences.
 
Services utilization, behaviors, self-care
Two recent systematic reviews and concept analyses (Sykes 2013, Sorenson 2012) identified the consequences of health literacy.  Both studies found the most frequently reported consequences of health literacy are improved use of services, behaviors, and self-care. These consequences reflect how people use their health literacy skills in everyday life and what they   actually do for health with the information and support available to them.  Although these consequences are supposed or anticipated rather than evidence-based (Sykes 2013), the documented presence of these consequences would indicate that the person possesses and has used health literacy skills to produce them. Studies using the Life Skills Progression instrument to assess maternal heath literacy are building the evidence base.
 
The LSP  Maternal Health Literacy Scales rate mothers health literacy by their health and healthcare-related actions practices and behaviors. Sequential measures show change —improvement or regression.  The LSP Healthcare Literacy Scale uses 9 items to rate mothers’ use of information, emergency services, medical and dental care and preventive services for herself and her child. The Selfcare Literacy Scale uses five items to assess risk behaviors and selfcare practices.  Three  published studies using LSP data on three different cohorts of mother-child dyads  provide evidence that mothers supported by home visitors trained to promote maternal heath literacy produced the consequences of health literacy at increasing levels over 12-18 months.  So the recent analyses of the consequences of health literacy confirm earlier findings that the LSP can be used as  meaningful measure of MHL.
 
Next: the recently identified unique consequences of critical health literacy add weight to our theory that critical thinking skill, particularly reflection, is the active ingredient in health literacy  that enables mothers (and others) to transform their decisions into health promoting actions and outcomes. Stay tuned
 
 
References
Sorenson K. Van den  Broucke S, Fullam J, Doyle G, Pelikan J, et. al. (2012). Health Literacy and Public Health: A systematic review and integration of definitions and models. BMC Public Health12:80. http://www.biomedcentral.com/1471-2458/12/80.
 
Sykes S, Willis J, Rowlands G & Popple K. (2013). Understanding critical literacy: a concept analysis. Biomed Central Public Health:13:150. http:www.biomedcentral.com1471-2458/13/150

Smith, S. A., & Moore, E. J. (2012). Health literacy and depression in the context of home visitation. Maternal and Child Health Journal16, 1500-1508. 

Carroll LN, Smith SA & Thomson NR. (2014). The Parents as Teachers Health Literacy Demonstration Project: Integrating an Empowerment Model of Health Literacy Promotion into Home-Based Parent Education. Health Promotion Practice pii: 1524839914538968. [Epub ahead of print]. Available on Internet at: http://hpp.sagepub.com/content/early/2014/06/23/1524839914538968.abstract

Mobley S, Thomas S, Sutherland D, Hudgins, J, Ange B & Johnson M. (2014) Maternal Health Literacy Progression Among Rural Perinatal Women. Maternal Child Health J 18: 1881-1892. 
Sandra Smith, PhD, MPH sandras@u.washington.edu
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