Health Literacy: Action Guide Part 2 “Evidence and Case Studies”

The World Health Communication Associates (WHCA) Action Guide on Health Literacy introduces an interactive action framework for strengthening individual and societal health literacy. It is written for health professionals, educators, policy makers, and advocates. Health literacy is defined as "the capacity to obtain, interpret and understand basic health information and services and the competence to use such information and services to enhance health." The guide’s primary aim is to be a "how-to" manual. It has been produced in two sections, one explaining health advocacy and the steps to take action and the other presenting the importance of health literacy and how it is measured, along with case studies to show how it can be strengthened through educational systems, media market places, home and community settings, workplace settings, and policy-making arenas.

To this end, the second in this set of documents presents case study examples of practical interventions that people and agencies in a wide variety of settings are undertaking (and can take) to enhance their own and others' health literacy. The actions described not only focus on individual behaviour changes but also look at initiatives being taken to strengthen and adjust systems in order to address institutional and structural deterrents to health literacy, make information more accessible and understandable, and make navigation easier. It attempts to answer the following questions:

1. "What is health literacy?
   
2. Why is health literacy important?
   
3. How is health literacy measured?
   
4. What can individuals, agencies, and systems do to strengthen health literacy?
   
5. How can we advocate for more attention, investment and action to strengthen health literacy?
   
6. What should be the components of a national or local health literacy strengthening action plan?"
   

Related to communication, the provision of written/printed materials suggests how to create simplified and attractive messages; visual aids; and internet, mobile phones, and other telecommunication interventions, including webpages in local languages, telephone message delivery, and educational centres using such techniques as interactive games and text messaging to improve literacy. It also describes culturally sensitive training needs. On page 36, there is an evidence-based vignette on chronic disease management programmes that are designed to identify and overcome literacy-related barriers to care. Effective verbal communication techniques are charted on page 38, followed by case studies and lessons learnt for each.

The section on education includes criteria health education curricula followed by case studies. Criteria are listed as:

• "Be research-based and theory-driven.
  
• Include information that is accurate and developmentally appropriate.
  
• Actively engage students using interactive activities.
  
• All students to model and practise relevant social skills.
  
• Discuss how social or media influences affect behaviour.
  
• Support health-enhancing behaviour.
  
• Provide adequate time for students to gain knowledge and skills.
• Train teachers to effectively convey the material."
  

Section 5 describes messages to key stakeholders who are: the general public; policy makers; health advocates and professionals; researchers; and educators. Section 6 lists 6 points for building national and local health literacy action plans:

1. "Recognise the problem and its significance. Include health literacy on your action agenda.
   
2. Support improvements in education and information access.
   
3. Build health literacy friendly systems that better align demands with skills.
   
4. Set, measure, and evaluate goals for improved alignment of skills/ability with task demands/complexity.
   
5. Engage with members of your target population at all stages of planning, implementation and evaluation."