Health Literacy

This week Shaun Bowes takes the wheel and becomes our first guest blogger. Hailing from Australia he has just completed his Masters of Teaching from Monash University and at 23 he’ll become ‘one of us’ when he starts applying for teaching positions in 2016. Please welcome him as he writes on a subject about which he is most passionate – Health Literacy.


I have been fortunate enough to interact with health educators across the globe, which has provided myself with an opportunity to write a blog post on health literacy. A lot of confusion still exists regarding what health literacy means and what it means for us educators, therefore this post will aim to eliminate that confusion. This post will benefit educators, parents, and individuals who work with children, especially for those in a health setting.

 The history of the term ‘health literacy’

The term ‘health literacy’ emerged in the 1970’s, but did not gain momentum until the 1990’s, when it began regularly appearing in academic literature.

The literature started to value the role of education in achieving health & wellbeing. This included an emphasis on lifelong ability to gain access to, understand & use health information & navigate systems/services by communicating & generating information to promote own & others health, wellbeing & physical activity. Health literacy was then actualised through empowerment and confidence to make informed decisions in regard to health.

What is health literacy?


As an overview, health literacy refers to how people understand information about health and health care, and how they apply that information (knowledge) to their lives, & use it to make decisions. Let’s look at what the literature says about health literacy however, to gain a bit of clarity about what it means to be health literate.

  •  “The ability to selectively access and critically analyse information, navigate community services and resources, and take action to promote personal health and the health of others” (ACARA, 2012).
  • “Content specific literacy in a health context” and “the literacy and cognitive skills that determine a person’s ability to access, understand, and use information for health” (Nutbeam, 2010, p.10).
  •  Kilgour, Matthews, Christian & Shire (2012) identify health literacy as a health promotion concept which “is concerned with empowering people” via improved knowledge and choice making capabilities.
  •  “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 US Institute of Medicine
  •  “The capacity of an individual to obtain, interpret and understand basic health information and services in ways that are health-enhancing” – UK National Consumer Council (2004)

Lastly, Paakkari & Paakkari (2011) discuss the World Health Organisations (WHO) board approach to health literacy whereby, “health literacy means more than being able to read pamphlets and make appointments” (p. 134). It relates to both an individual and community approach to take action regarding health, as well as the ability to obtain a healthy lifestyle and improve living conditions.

According to Paakkari & Paakkari (2012), health literacy has 5 core components; theoretical knowledge, practical knowledge, critical thinking, self-awareness and citizenship. Paakkari & Paakkari (2012) mention that in the best possible situation, all 5 components are intertwined with each other to form the highest level of health literacy.

In summary, individual health literacy relates to skills, knowledge, motivation and the capacity of a person to access, understand, appraise and apply information to make effective decisions about health and health care, and take action. These skills & behaviours may include; reading about what foods are required for healthy eating & the motivation to participate in a rehabilitation clinic, which encompasses the ability to read, comprehend and analyse information. These abilities may include decoding symbols & diagrams; weighing up risks and benefits; and using information to make decisions and act upon them.

Why is health literacy important?

It is important because it shapes people’s health, and the safety and quality of health care. It is important because there is consistent evidence that indicates associations between individual health literacy, health behaviours and health outcomes.

Individuals who are “more” health literate will be able to access and participate within society and the health care system to a larger extent.

Direct benefits include:

  • Participation in preventative health care measures
  • Early detection and management of disease
  • Improved access and appropriate use of health care services
  • Improved patient compliance to treatment plans

Other benefits include:

  • It enables individuals to have a greater understanding on their overall health as well as the range of personal, social and environmental determinants of health.
  • It gives an individual greater empowerment in their health decision-making.
  • Health literacy allows individuals to apply meaningful information to personal and family health circumstances.
  • It encourages people to engage in social action and advocacy for health.
  • It represents the cognitive and social skills that determine the motivation and the ability of individual to gain access to understand and use information in ways, which promote and maintain good health.
  • Health literacy can be viewed as a process through which young people can learn and become empowered to take social action that can positively influence the determinants of health.
  • In 1984, WHO began to prioritize the importance of the individual within their ‘total environment’ and that health was far beyond the control of the individual. With that being said, it is important to raise competence, knowledge and awareness about the personal, social and environmental factors that influence health.

According to the National Assessment of Adult Literacy, only 12% of adults have sufficient health literacy, which means that these adults lack the skills to manage their health and prevent disease. Improving health literacy within schools can dramatically improve these statistics. Australian Commission on Safety and Quality in Health Care: In Australia it has been estimated that almost 60% of adults have a low level of individual health literacy (and even higher for those with ESL). People with low individual health literacy are between one-and-a-half and three times more likely to experience an adverse outcome. They are also more likely to be hospitalised, misunderstand medication labels or instructions, or know less about their condition than those with a higher level of health literacy. In the United States, people with lower health literacy spend between $143 US and $798 US per person per year more on health services.

Health Education Implications

  • The teaching and development of health literacy is multi-faceted and built over many years.
  • Experiential learning is encouraged as health literacy surrounds the student’s ability to apply their knowledge (skill based).
  • As Health Educators we need to be aware of the importance of developing health literate students, by including a range of activities that move from knowledge acquisition to knowledge application.
  • The skills that students gain will aid them in decision-making about their own health and potentially that of others, so it is critical that these skills are gained.
  • School health education provides important foundations for health literacy- begins to build knowledge and understandings of our choices towards our overall health and wellbeing.
  • To develop knowledge and understanding about health.
  • Schools are recognized as key settings for developing health-related knowledge and skills.

Integrating health literacy into education:

Education plays a large role in promoting and maintaining health as it provides people with the tools needed to shift to more effective methods of health care, and it provides them with the support and motivation to implement new and unfamiliar processes. Your role as educators is to assist students in; acquiring age-appropriate knowledge to support informed health choices, develop and practise skills and strategies to act upon individual decisions, recognise the values and attitudes that may influence lifestyle choice and behaviour (hygiene, good eating habits, sun protection and other preventive health messages).

Incorporating health literacy into a lesson

Things that can be used;

-Interactive games.

-Video clips incorporated into lessons to provide emphasis or further explanation.

-Projects where students research the specific topic to meet certain questions or criteria outcomes.

-Group or individual presentations to the class to show knowledge application and understanding of content to teach and learn from other students.


Click this link for an example of implementing health literacy into a lesson


A specific example of a focus area that could be used is mental health. Students age ranges from (years 10-12) can break up into groups or individually to prepare a presentation to the class to explore a chosen mental health disease that affects individuals in modern day society.

The students can use a range of methods to present the content; through poster format, power point, a drama play, a storyboard, guest speakers, a mind map explanation, or an interactive game.

The resources can be sourced electronically through multi-media clips such as (You-tube, DVDs or video), books, professional advice, a specific mental health society, individuals who have dealt with a mental illness, the internet-google scholar, Case studies that have been carried out, observations of individuals with mental illness and general practitioners.

Areas of focus for the health literacy project would be;

-Identify and provide detailed explanation/definition of the mental illness.

-Show statistics of how the specific mental illness affects individuals in (Country) with evidence of relevant and current data.

-What can be done to remedy the specific mental illness and how (Country) health care system can help the individuals?

-Specific examples of how the mental illness affects the individual(s) in everyday life and the coping mechanisms that can be used.

-How health literature helps society when dealing with someone with a mental illness.

*If anyone is interested in understanding how we measure it then contact me on Twitter @MrBowesHPE

References can be found at the end of this post, but here are this weeks daily #slowchathealth questions. They will posted each morning but feel free to answer them in any order! Let’s keep the conversation flowing on this topic.

Q1. Define health literacy in 140 characters or less. #slowchathealth

Q2. How, if at all, is health literacy stated in your #healthed curriculum? #slowchathealth

Q3. Why do you think health literacy is important? #slowchathealth

Q4. What are you doing to ensure that your Ss will be health literate when they leave school? #slowchathealth

Q5. How do you provide opportunities for your students to demonstrate their health literacy? #slowchathealth


ACARA (2012). The Shape of the Australian Curriculum: Health and Physical Education, 4-5.

Alfrey, L., & Brown, T.D. (2013). Health literacy and the Australian Curriculum for Health and Physical Education: a marriage of convenience or a process of empowerment? Asia-Pacific Journal of Health, Sport and Physical Education, 4(2), 159-173.

Chin, D. (2011). Critical health literacy: a review and critical analysis. Social Science & Medicine, 73, 60-67.

Kilgour, L., Matthews, N., Christian, P., & Shire, J. (2012). Health literacy in schools: prioritising health and well-being issues through the curriculum. Sports, Education and Society. Retrieved from

Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. 1993. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey (NALS). Washington, DC: National Center for Education Statistics, U.S. Department of Education.

Nutbeam, D. (2010). The evolving concept of health literacy [Power Point slide]. Retrieved from EDF4864, Monash University Moodle Online:

Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67, 2072-2078.

Paakkari, L., & Paakkari, O. (2011). Health literacy as a learning outcome in schools. Health education, 112(2), p. 133-152. DOI 10.1108/09654281211203411

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