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North Carolina Health Literacy: Health Literacy Basics

This guide serves as the information hub for health literacy resources and efforts at University of North Carolina at Chapel Hill, as well as throughout the state of North Carolina.

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What is in this guide?

Our mission is to promote health literacy in order to improve health outcomes for all North Carolinians. On our site, we offer a number of vetted resources that will help you incorporate health literacy in your practice, such as:

Upcoming Workshop: Clear Health Communication

Clear Health Communication Workshop Flyer

Register for the next Clear Health Communication Workshop at https://calendar.lib.unc.edu/event/11900557

About Us

The North Carolina Health Literacy website serves as the information hub for health literacy resources and efforts at University of North Carolina at Chapel Hill, as well as throughout the state of North Carolina. Our work includes outreach to rural and underserved communities. We offer workshops and training for students, educators and health care workers on health literacy principles. We also provide information on strategies and tools to incorporate health literacy into practice in order to improve health outcomes.

NC Health Literacy was established by the Sheps Center for Health Services Research in 2007. Today, we are an integral part of the Health Sciences Library. The Health Sciences Library supports the work of the University to enhance the quality of life for all people in the State by connecting people everywhere with knowledge to improve health.

What is Health Literacy?

Healthy People 2030 breaks health literacy into personal health literacy and organizational health literacy.

  • "Personal health literacy is the degree to which individuals have the ability to find, understand and use information services to inform health-related decisions and actions for themselves and others. 
  • Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others." (ODPHP)

Health literacy requires basic reading skills and the ability to comprehend oral communication, as well as using numbers and math. It also entails knowing how to navigate the healthcare system and communicate with health care providers. These skills are necessary in order to:

  • Communicate health concerns to provider
  • Read prescriptions and understand treatment plans
  • Implement self-care strategy and manage health
  • Understand warning labels and potentially life-threatening complications
  • Comprehend health insurance forms, informed consent, and public assistance applications

Learn more about the basics of health literacy, including understanding health literacy and numeracy at Health Literacy Basics (CDC).

Santana, S., Brach, C., Harris, L., Ochiai, E., Blakey, C., Bevington, F., Kleinman, D., & Pronk, N. (2021). Updating health literacy for healthy people 2030: defining its importance for a new decade in public health. Journal of Public Health Management and Practice : JPHMP, 27(Suppl 6), S258–S264. https://doi.org/10.1097/PHH.0000000000001324

Office of Disease Prevention and Health Promotion (ODPHP) https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030

 

History of Health Literacy Definitions

In recent years, a growing number of people have advocated for increasing the focus on the organizational aspect of health literacy. In developing Healthy People 2030, the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 proposed expanding Healthy People’s view on health literacy. The definition of health literacy used in Healthy People 2010 and 2020 was “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

The new, Healthy People 2030 definitions of personal and organizational health literacy

  1. highlight the importance of people being able to use health information, not just understand it;
  2. shift the focus from “appropriate” health decisions to “well-informed” health related decisions; and
  3. emphasize that organizations, health professionals, and healthcare institutions have an important role to play in addressing health literacy.

Health professionals and organizations can and have a responsibility to take actions to make health information and healthcare systems easier to understand and to navigate to improve health equity.  

Santana, S., Brach, C., Harris, L., Ochiai, E., Blakey, C., Bevington, F., Kleinman, D., & Pronk, N. (2021). Updating health literacy for healthy people 2030: defining its importance for a new decade in public health. Journal of Public Health Management and Practice : JPHMP, 27(Suppl 6), S258–S264. https://doi.org/10.1097/PHH.0000000000001324

Office of Disease Prevention and Health Promotion (ODPHP) https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030

 

The Impact of Low Health Literacy

It is estimated that nearly one-quarter of the U.S. population has low health literacy. Within that group, almost a third described their physical health as “fair” or “poor,” considerably higher than the general population. The cost of low health literacy to the U.S. economy is estimated to be between $106 billion and $238 billion per year (Vernon et al. 2007). Low health literacy is especially pronounced in North Carolina. State level estimates place North Carolina 41st in terms of ranking compared to other states (NCIOM). A disproportionate number of those with low health literacy are older adults, the medically underserved, and people with low socioeconomic status.

Low health literacy is associated with:

  • Lack of knowledge and understanding of health conditions and services
  • Inability to implement appropriate self-care activities
  • Difficulty understanding medication instructions and adhering to treatment
  • Lower utilization of preventive care and services
  • Increased hospitalizations and health care costs
  • Worse health outcomes and increased mortality

Vernon, J. A., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national health policy. Washington, DC: Department of Health Policy, School of Public Health and Health Services, The George Washington University. https://hsrc.himmelfarb.gwu.edu/sphhs_policy_facpubs/172/

North Carolina Institute of Medicine. (2007). Just WhatDid the Doctor Order? Addressing Low Health Literacy in North Carolina. NC IOM Task Force on Health Literacy.https://nciom.org/wp-content/uploads/2017/07/HealthLiteracy_FinalReport.pdf

 

Health Literacy and Misinformation

What is Misinformation?

Misinformation is generally characterized as “false, inaccurate, or misleading according to the best available evidence at the time.” (Office of the U.S. Surgeon General 2021)

 

Over the last few years, health misinformation has garnered a lot of attention and concern among health professionals and public health agencies. During the COVID-19 pandemic, widespread misinformation contributed to vaccine hesitancy, improper use of medications or unproven treatments, and hostility towards people tasked with enforcing public health policies.

How it spreads

Misinformation spreads quickly online and on social media platforms that encourage sharing sensational or controversial information, or recommend content based on what you have previously viewed. Since there is so much information available online, it can be hard to spot misinformation. Sometimes well-intentioned people share misinformation because they don't realize that it is biased, inaccurate, or out-of-date. Sometimes people knowingly spread false or misleading information to make money, or to support a cause or person.

What does it have to do with health literacy?

The U.S. Surgeon General’s Advisory on Building a Health Information Environment (2021) says that “misinformation also thrives in the absence of easily accessible, credible information.” Clear communication and health literacy programs can help to combat misinformation by providing people with the resources and skills to find, identify, and use good health information.

Office of the U.S. Surgeon General. (2021). Confronting Health Misinformation: The U.S. Surgeon General’s Advisory on Building a Healthy Information Environment. U.S. Public Health Service.https://www.hhs.gov/surgeongeneral/priorities/health-misinformation/index.html

 

Learn to evaluate online health information

Terri Ottosen, MLIS, AHIP

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Terri Ottosen