GRF 2nd One Health Summit 2013: Presentation by Shana Gililette, Colorado State University

1. One Health Literacy: Concepts
and Measurement
Shana Gillette
Assistant Professor in Risk Communication
Dept. of Clinical Sciences

2. “The degree to which individuals have
the capacity to obtain, process, and
understand basic health information and
services needed to make appropriate
health decisions.”
(Ratzan and Parker, 2000)

3. More than one third of adults in the
United States have difficulty with
common health tasks, such as following
directions on a prescription drug label.
(U.S. Department of Health and Human Services 2009)

4. Low or limited health literacy is linked
with adverse health outcomes such as
poorer self-management, less healthy
behaviors, higher mortality, and overall
poorer health.
(Piette, Wang, Osmond, Daher, Palacios, Sullivan, &
Bindman, 2002; Baker, Gazmararian, Williams,
Scott, Parker,Green Wren, & Peel 2004; Baker, Wolf,
Fineglass, Thompson, Gazmarian, & Huang 2007)

5. Health
Outcomes
Health
Literacy
Healthy
Lifestyles &
Environments;
more effective
Health Services

6. Instruments used to assess health
literacy:
• NAAL (National Assessment of Adult Literacy)
• REALM (Rapid Estimate of Adult Literacy in
Medicine)
• TOFHLA (Test of Functional Health Literacy in
Adults)

7. A Broader Measurement of Health
Literacy—beyond reading and writing
what literacy enables us to do:
(Freebody and Luke 1990)
– Basic/Functional Literacy
– Communicative/Interactive Literacy
– Critical Literacy

8. Functional Literacy:
– Reading and writing linked to
everyday tasks
– Most current tools measure some
form of basic/functional literacy

9. Interactive Literacy:
• Use social skills to complete interactive
tasks such as:
– Listen to treatment options
– Describe symptoms
– Make an appointment

10. Critical Literacy:
• Reconcile information from different
sources, expert and non-expert
• Reflect on the options available
• Take action on a decision based on
critical reflection

11. Expansion of Health Literacy Definition
from:
“The degree to which individuals have
the capacity to obtain, process, and
understand basic health information and
services needed to make appropriate
health decisions.”
(Ratzan and Parker, 2000)

12. Expansion of Health Literacy Definition
to:
“Health literacy represents the cognitive
and social skills which determine the
motivation and ability of people to gain
access to, understand, and use
information in ways that promote and
maintain good health and are critical to
health empowerment.”
(Nutbeam on WHO, 1998)

13. Causal Pathways: Health Literacy & Outcomes
Paasche-Orlow and Wolf, 2007
American Journal of Health Behavior

14. Conceptual Framework for Individual Health Literacy
McCormack, 2009 in NAS, 2009

15. Conceptual Framework for Individual Health Literacy
McCormack, 2009, in NAS 2009
Health
Literacy
Skills
Stimulus
Capabilities

16. Conceptual Framework for Individual Health Literacy
McCormack, 2009, in NAS 2009
Health
Literacy
Skills
Stimulus
Capabilities
Shared
Health

17. Measuring One Health Literacy:
Measure Progression of Functioning
– From inability to optimal
– Measures of Literacy and SelfCare
• Reduce risk of low literacy increase
functioning directly
• Apply to a life course model

18. Measuring One Health Literacy:
Map Literacy to Identify High Risk Areas
Literacy, quality of care, health outcomes
– When is there a negative effect?
– Can there be a protective effect?
– How do they interact?

19. Measuring One Health Literacy:
Incorporate Emerging Media
– Increase immediacy of measurement
– Analyze social dynamics of literacy
– Analyze cultural dynamics of literacy

20. One Health Literacy is at the core of
the health literacy framework
QUESTIONS?