Previously in this space, we talked about the identified consequences
of health literacy. I argued that the documented presence of those
consequences in a mother’s (or other’s) life would be
evidence that she possesses and
used health literacy skills to produce those consequences. Now we look specifically at critical
health literacy and its consequences. Nutbeam (2000, 2008) followed literacy scholars Freebody and
Luke (1990) to name levels, or, more accurately, categories of health literacy:
functional/technical skills (ability to read and use numbers);
interactive/social skills (listening, speaking) and critical health literacy,
critical thinking skills that enable a person to apply information in new
circumstances (Nutbeam 2000) in one’s own life (Kickbush 2001). While critical skills are commonly considered advanced or higher
level skills, some literacy scholars (Charner-Laird, Fiarman, Park, Soderber & Nunes, 2003)
have argued that critical
thinking, especially reflection, is so essential to making meaning from
information and using it in context, that it should be considered a basic
skill. They describe reflection as the “mind’s strongest glue” for making
connections essential to understanding any subject. Maternal health literacy includes all three
categories of health literacy skills, which mothers use in various combinations
according to the task and the context. Strong skills in one category (say
listening and remembering) can compensate for lesser skill in another category
(like reading). Is Critical Health Literacy different from Health Literacy? Sykes and colleagues (2013) wanted to know if critical health
literacy is really different from associated concepts like health literacy and
empowerment. So they analyzed the literature on critical health literacy and
interviewed UK health literacy experts. They concluded that critical health
literacy is indeed a unique concept differentiated from related concepts by its
consequences: confidence or self-efficacy, improved quality of life, increased social capital, and improved health outcomes. The unique consequences of critical
heath literacy suggest that critical thinking is the active ingredient in
health literacy that leads to action and outcomes. This adds weight to our
operating theory at Beginnings Guides and the Center for Health Literacy
Promotion that reflection is a key lifeskill for mothers taking responsibility
for family health. The Active Ingredient in Health Literacy: critical thinking
skills My friend and colleague, home visiting expert Linda Wollesen
has been saying for decades that mothers make progress when home visitors,
parent educators (I’ll add patient educators and health
educators) stop giving answers and instead ask questions that make mothers
think. In the process of working out answers to reflective questions mothers
learn to look objectively, critically at a situation to make sense of it and
choose a purposeful response, to formulate their own questions for information
seeking, to interpret information and use it for practical purposes in their
everyday lives. Basic health literacy, described as reading and numeracy skills
used to understand basic information needed to make appropriate health
decisions (Monday I will quit smoking) is insufficient to affect outcomes.
Action is required for outcomes, often sustained and difficult action. And
critical thinking skills are required to plan action, progress in the face of
barriers, and produce desired outcomes. So to be health literate, mothers and
others need skills in all three categories: functional, interactive and
critical health literacy. And the greatest of these is critical health literacy
— thinking skills to respond intentionally to the health
challenges and opportunities of everyday life. References Nutbeam D. (2000)Nutbeam, D.
(2000). Health literacy as a public health goal: a challenge for contemporary
health education and communication strategies into the 21st Century. Health
Promotion International, 15, 259267. Nutbeam, D. (2008). The evolving
concept of health literacy. Social Science & Medicine, 67, 2072-2078. Kickbush,IS. (2001).Health
Literacy: addressing the health and education divide. Health Promotion
International 16 (3), 289-297. 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 |