Health Literacy: A Necessary Element for Achieving Health Equity

The 2008 World Health Report emphasizes the need for patient-centered primary care service delivery models in which patients are equal partners in the planning and management of their health. It is argued that this involvement will lead to improved management of disease, improved health outcomes and patient satisfaction, better informed decision-making, increased compliance with healthcare decisions, and better resource utilization. This article investigates the domains captured by the Effective Consumer Scale (EC-17) in relation to vulnerable population groups that experience health inequity. Particular focus is paid to the domain of health literacy as an area fundamental to patients’ involvement in managing their condition and negotiating the healthcare system. In examining the possible influence of Outcome Measures in Rheumatology Clinical Trials (OMERACT) on health equity, we used the recent translation and validation of the EC-17 scale into Spanish and tested Argentina as an example. Future plans to use the EC-17 with vulnerable groups include formal collaboration and needs assessment with the community to tailor an intervention to meet its needs in a culturally relevant manner. Some systematic reviews have questioned whether interventions to improve effective consumer skills are appropriate in vulnerable populations. We propose that these populations may have the most to gain from such interventions since they might be expected to have relatively lower skills and health literacy than other groups.

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Health Equity Demands Health Literacy

Pediatric Emergency Care ◽

10.1097/pec.0000000000001660 ◽

2018 ◽

Vol Publish Ahead of Print ◽

Author(s):

Naomi Dreisinger ◽

Jeffrey Nahn

Keyword(s):

Health Literacy ◽

Health Equity

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Re-prioritizing Digital Health and Health Literacy in Healthy People 2030 to Affect Health Equity

Health Communication ◽

10.1080/10410236.2020.1748828 ◽

2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Devlon N. Jackson ◽

Neha Trivedi ◽

Cynthia Baur

Keyword(s):

Health Literacy ◽

Health Equity ◽

Digital Health ◽

Healthy People

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The Intersection of Health Literacy, Health Equity, and Nursing Practice

Health Equity and Nursing ◽

10.1891/9780826195074.0017 ◽

2020 ◽

Author(s):

Diana Peña Gonzalez ◽

Rachel Roberts ◽

Kirby Johnson

Keyword(s):

Health Literacy ◽

Health Equity ◽

Nursing Practice

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Questionnaire validation practice within a theoretical framework: a systematic descriptive literature review of health literacy assessments

BMJ Open ◽

10.1136/bmjopen-2019-035974 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035974

Author(s):

Melanie Hawkins ◽

Gerald R Elsworth ◽

Elizabeth Hoban ◽

Richard H Osborne

Keyword(s):

Health Literacy ◽

Literature Review ◽

Health Equity ◽

Theoretical Framework ◽

Evidence Based ◽

Validity Evidence ◽

Validity Testing ◽

Testing Framework ◽

Literacy Assessments ◽

Health Assessments

ObjectiveValidity refers to the extent to which evidence and theory support the adequacy and appropriateness of inferences based on score interpretations. The health sector is lacking a theoretically-driven framework for the development, testing and use of health assessments. This study used the Standards for Educational and Psychological Testing framework of five sources of validity evidence to assess the types of evidence reported for health literacy assessments, and to identify studies that referred to a theoretical validity testing framework.MethodsA systematic descriptive literature review investigated methods and results in health literacy assessment development, application and validity testing studies. Electronic searches were conducted in EBSCOhost, Embase, Open Access Theses and Dissertations and ProQuest Dissertations. Data were coded to the Standards’ five sources of validity evidence, and for reference to a validity testing framework.ResultsCoding on 46 studies resulted in 195 instances of validity evidence across the five sources. Only nine studies directly or indirectly referenced a validity testing framework. Evidence based on relations to other variables is most frequently reported.ConclusionsThe health and health equity of individuals and populations are increasingly dependent on decisions based on data collected through health assessments. An evidence-based theoretical framework provides structure and coherence to existing evidence and stipulates where further evidence is required to evaluate the extent to which data are valid for an intended purpose. This review demonstrates the use of the Standards’ theoretical validity testing framework to evaluate sources of evidence reported for health literacy assessments. Findings indicate that theoretical validity testing frameworks are rarely used to collate and evaluate evidence in validation practice for health literacy assessments. Use of the Standards’ theoretical validity testing framework would improve evaluation of the evidence for inferences derived from health assessment data on which public health and health equity decisions are based.

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Using the Health Literacy Questionnaire (HLQ) with Providers in the Early Intervention Setting: A Qualitative Validity Testing Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072603 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2603 ◽

Cited By ~ 1

Author(s):

Catherine J. Leslie ◽

Melanie Hawkins ◽

Diane L. Smith

Keyword(s):

Early Intervention ◽

Health Literacy ◽

Health Equity ◽

The United States ◽

Validity Testing ◽

Child Health Outcomes ◽

Health Literacy Questionnaire ◽

Low Health Literacy ◽

Study Results ◽

Provider Perspective

More than one in four parents in the United States of America (USA) have low health literacy, which is associated with reduced health equity and negatively impacts child health outcomes. Early intervention (EI) programs are optimally placed to build the health literacy capacity of caregivers, which could improve health equity. The health literacy of interdisciplinary EI providers has not previously been measured. This study used the Health Literacy Questionnaire (HLQ) with EI providers (n = 10) to investigate evidence based on response (cognitive) processes. Narratives from cognitive interviews gave reasons for HLQ score choices, and concordance and discordance between HLQ item intent descriptions and narrative data were assessed using thematic analysis. Results found scales with highest concordance for Scales 3, 6, and 9 (each 96%, n = 24). Concordance was lowest on Scale 5 (88%, n = 22), although still strong with only 12% discordance. Three themes reflecting discordance were identified: (1) Differences between Australian and USA culture/health systems; (2) Healthcare provider perspective; and (3) Participants with no health problems to manage. Results show strong concordance between EI providers’ narrative responses and item intents. Study results contribute validity evidence for the use of HLQ data to inform interventions that build health literacy capacity of EI providers to then empower and build the health literacy of EI parents.

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