How do we know that focusing on health literacy makes a difference? The passing of Len Doak, co-author of the classic text Teaching Patients with Low Literacy Skills, places this question in a personal context. The question is also relevant for health research, evaluation and policy. Policymakers, managers, project funders, and professional and administrative staff want to know if paying attention to health literacy makes a difference.
Len and Ceci Doak and Jane Root wrote the book on health literacy practice in clinical settings. They were tireless advocates and made a difference by explaining health literacy and engaging others in the work. The large number of people drawn into health literacy because of their book and gracious mentorship is one type of difference.
But, decisionmakers typically want evidence of a different kind. They want measurable outcomes aligned with organizational or policy requirements to know if a change or intervention is worthwhile. Quality, cost and access are typical healthcare outcomes of interest. The two systematic reviews of evidence along with many single studies suggest that limited health literacy decreases healthcare quality and access and increases costs.
Defining outcomes for health literacy practice in public health is equally important. If we aim to reduce illness and death on a large scale, how can attention to health literacy help us get better public health outcomes?
For example, many different organizations provide health information to the public. Sometimes they use highly visible mass media campaigns directed at millions of people; other times they may use a web site and targeted promotion to a very specific audience.
The outcomes for mass media campaigns might include reach (did we reach the audiences we intended to reach?), recall (does the audience recall seeing our messages and do they recall specific messages?), and attitude change (did our messages change their attitudes?). Web site metrics might include most popular features, time spent on pages and number of downloads of site products. How might these outcomes help us learn about health literacy?
As we think about the many types of public health work that could benefit from health literacy insights, we should also think about the outcomes we want. Please share your ideas about outcomes you already address and outcomes you’d like to address from a health literacy perspective.