Start with measurement
What we measure and how we measure it matters because it determines what we
find out about what works and what’s worth doing and who should do it.* Measurement
remains the most crucial issue for health literacy research; because we need to find
out what works for whom, and what’s worth doing and who should do it.
I’m especially interested in what works for mothers in the prenatal to preschool
period. Because they are the foundation of personal and public health. Healthy mother…
healthy baby… healthy population. What mothers learn about health and healthcare
during pregnancy and early parenting can benefit entire families across their lifespans,
and extend benefits to the healthcare, education and justice systems, and to the economy.
Health literacy focuses on patients understanding healthcare information
Health literacy research assesses patients’ health literacy by their scores on a single
administration of a reading test using medical terms. Patients are marked poor, marginal
or adequate. An adequate score means you will probably not need assistance to make
meaning from information about your diagnosis or to follow treatment instructions. If
you cannot pronounce most of the words, you are assumed to have poor health literacy
and to be unable to “obtain, process and understand basic information needed to make
appropriate health decisions”.
What we find out from health literacy-reading test scores is that almost everybody has
limited medical vocabulary and difficulty making sense of information from the healthcare
system. We find out that information needs to be simplified and its delivery needs to be
improved. We find that patients score better when we give them better information and
conclude that what’s worth doing is improving information and its delivery. Since most
studies originate in academic medical centers, it is not surprising that studies position health
professionals as the keepers and dispensers of health and medical knowledge and so it falls
to them to reduce the risk and mitigate the negative impacts of low [health] literacy on
patients and the system.
Maternal health literacy focuses on parents using information for health
Maternal health literacy research assesses periodically what parents do with information,
how they integrate it into their lives and households. Changes in parent’s health- and
healthcare-related actions, practices and behaviors provide evidence of progress (or
regression) in developing the knowledge and social and cognitive skills needed to participate
in healthcare and preventive practices. This approach captures effects of systems efforts to
improve information as well as public health efforts to directly assist parents to make meaning
from the information and apply it in real life.
By monitoring what parents actually do for health with the information available to them, we
find out that direct assistance to use information and services for health is most beneficial to
lower functioning parents, while also benefitting higher functioning parents. We find that social
workers, parent educators, health educators, and trained paraprofessionals working in homes
and communities can enable parents to better manage family health and healthcare, even with
the added challenges of poverty, limited education and limited English proficiency.
Both approaches are needed
The dominant clinical approach to patient’s health literacy and the public health approach to
maternal health literacy are complementary rather than exclusive. Patients and parents need
quality information, accessible services, and assistance to use them effectively.
* lisabeth schorr Common Purpose: Strengthening Families and Neighborhoods to Rebuild America. http://lisbethschorr.org Read this book!