health literacy (who)

7/26/2019 Health Literacy (WHO)

1/46

ACKNOWLEDGMENTS

:

M K W M

C E M R, W H O.

T 7 G C H

P, "P H D: C I G", N, K,

2630 O 2009.

I , , , , , ,

, , . T

, WHO

.


2/46

P 2

CONTENTS

L A........... ..................... ...................... ..................... ..................... ...................... .................... ...................... ............ 2

E S.................... ..................... ...................... ...................... .................... ...................... .................... ......... 4

F..... ...................... ..................... ...................... ...................... .................... ...................... ..................... ...................... ............... 8

W ?...................... ..................... ...................... .................... ...................... ...................... .................... ...................... ..... 9

W ?.......................... ..................... ...................... .................... ...................... ..................... ..................... ...... 10

W ? .................. ...................... ...................... .................... ...................... ..................... ............. 16

1. T ..................... ...................... ...................... .................... ...................... ......... 16

2. R ............................ ...................... ..................... ..................... ...................... ............ 19

3. I ................... ...................... ...................... .................... ...................... ................ 21

4. H .................... ..................... ...................... ...................... .................... ...................... .................... .......... 23

5. H ..................... ..................... ...................... .................... ...................... ...................... ..... 24

6. E..................... ...................... .................... ...................... ..................... ..................... ..................... ...................... ......... 25

H ?....... ...................... ...................... .................... ...................... .. 26

W ? ...................... ..................... ..................... ............. 28

H ?.............................. ...................... .................... ...................... ...................... ..................... .. 33

W ?.......................... ...................... .................... ...................... .................... 35

W EMRO ? ................... ................. 37

M .................... ...................... ..................... ...................... .................... ...................... ..................... ..................... ................. 38

O F .................... ...................... ...................... .................... ...................... ...................... .................... .......... 38

S F ................... ..................... ...................... ...................... .................... ...................... ..................... .................... 39

G R......................... ..................... ...................... .................... ...................... ..................... ............. 41

N S.................... ..................... ..................... ...................... .................... ...................... ..................... ..................... ................. 42

A 1. M S R H L, B O ................... .................... 44

A 2. S R E S ................... ...................... ..................... ...................... ................ 46

LIST OF ABBREVIATIONS


3/46

P 3

CQI C Q I

HIV H I V

NCD N /

PDSA P/D/S/A

R

SEAR/SEARO S E A R/ S E A R O

WPR/ WPRO W P R/ W P R O


4/46

P 4

EXECUTIVE SUMMARY

T 21 ,

. T

, , .

H . H

.O

, .

W , ,

T , ,

.

T :

: S ,

, , , ,

, ,

.

: T ,

, , ,

, , .

: S

: ;

,

,

.

W ? T

:

1. : EMR , ,

79 . I EMRO Q UAE.

2. : .

3. : I EMR, (47%) .H .

4. : 3 5%


5/46

P 5

5. : .O, .

6. : , , . I

T R E A L M (REALM), T F H L

A (TOFHLA), N V

S . U,

. T . T H

A L S (HALS) . B

: I , , . N,

HALS .

W

25 ?

F , U S. T .

S , , .

M , ;

C . F , .

W

EMR. S

, ,

(G). T

,

. T

; ( ),

( ) (

) .


6/46

P 6

S 1994 2009 . M (14)

.

I (2)

. T

, , , , A

. O M P.

E , , (, DVD), ( ),

. T

, ,

, , , ( , ), (

) ( ). T

( , , ,

, ) , .

T

, ,

.

W

. O :

: A / .

O

M H Q (MHLQ). B ,

;

.

W A W S O (AWSO) I ,

, ,

,

.

A J R L L W

. B

, . R

36% 1997 60 % 2001.


7/46

P 7

A ,

: W I . T .D /. O ,

, .

:N / . C, , . T .

:M (.. ). T , . S

: , .

:T . W , E M , .

: I, HIV/AIDS, , , , , , , , , , , . . M EMR .

T 7G C H P N, K O 2630

. C

:

I

(ICT)

I

I

D


8/46

P 8

FORWARD

T

7 G C

H P O 2630, 2009 N, K. S :

;

, , ; ,

EMRO/WHO .

A ,

. T

; , ,

, .

T

.

T , , . M

,

EMRO. A

,

,

,

.

T ; .

W

. I , ,

. O

, ,

R.

,

,

.


9/46

P 9

WHAT IS LITERACY?

L, , , , , ,

. H

.1 B . I

.2

T 21 ,

. T

, , .3 T U

N E, S C O (UNESCO)

, " , , , ,

, .

L ,

, ."4

U , U N 80%

' 1998.5O ,

" 15 ",

2008 82% (87% 77% ).6L

, '

. H, ; ,

.

F 1 .

1N C T E. ://..///21

2://..//L

3I

4 UNESCO E S, T P L P P: P

P. P: U N E, S C O, 2004, . 13,

J 2003 UNESCO. ://..//0013/001362/136246.

5 ://..//.

6 W F, C S 08, 2009. ://..///

//2103., S 11, 2009

,

,

.


10/46

P 10

FIGURE 1. GLOBAL LITERACY RATES BY COUNTRY

WHAT IS HEALTH LITERACY?

H

.7H

. O

, .

W ,

,

T ,

,

8

A I M (IOM)9, ,

7G, G., & Q, A. (2004).T B: S . H

N . ://..////.

8 K, B, F, J, R, I (2006). T " "

. V: U B C I H P R &

U V C C H P R.

9 . , DC: N A P; 2004. H L: A P E

C.

,

,

.

.

R, I. (2009) P UV


11/46

P 11

,

. W , IOM

, '

, ,

, , .10T R

:

.11 T F 2

.

FIGURE 2. HEALTH LITERACY FRAMEWORK DEVELOPED BY THE US INSTITUTE OF

MEDICINE (2004)

K, F R

() ,

( 3).12

FIGURE 3. FACTORS AND CONTEXTS THAT INFLUENCE HEALTH KNOWLEDGE, DECISIONS

AND ACTIONS

10P, R., & K, D. (2006). B I M H L R: A R B T S? J G I M, 21(8): 891892.://.../.?=1831577

11R, I. (2009). H L: W ? P U V, BC.

C.

12K, B., F, J., R, I. (2006). T D V M H

L D P, V: C P H P R.

...


12/46

P 12

Access orexposureto health

information

Understandhealth

information

Appraisehealth

informationCommunicate

healthinformation

Health knowledge

GeneralReading

WritingListeningSpeakingNumeracy

Other

ScientificComputerCultural

Media

Literacy

H e a l t h I n f o r m a t i o n C o n t e x t

Health

decisions

Healthactions

Outcomes

PersonalValues, attitudes, beliefs,

knowledge, motivation, skills,behaviour, personal capacity,

biology, previous life experiences,

current physical and psychological state

External

Income, social status,social support, education system,health system, social environment,employment and working conditions,physical environment, culture,communication systems, research,

economic environment

Other Factors

(Factors with respect to the individual seeking information,

the sources of information, and the information itself)

Version date: May 23, 2006

C, , ,

. A , , ,

:13

(.., , );

(.., ; ;

;

, ;

);

(.., , ,

);

(.., , , );

T

(.., ,

, );

O , ,

, .

13N I H. ://..////PAR04116.


13/46

P 13

T ' ' 1974, ,

..14 T

, ,

15.1617T

K 1997.18 I

19 N,

,

.20

N

. A ,

:21

:

;

:

;

:

.

I ,

"."22K

.23W

14S, SK. 9.

15C C S S O (CCSSO). (1998). A : A ;S C, C. TE P.

16B, DW., P, RM., W, MV., C, WS., & N, J. (1997), T

. A J P H. 87, 10271039.

17W, MV. .. , (1995). I

() JAMA. 274(21), 16771682.

18K, I. (1997). T : W ? H P I, 12, 265272.

19N, D. (1998). H P G, H P I, 13. 349364.

20N, D. (2000). H : A 21. H P I, 15, 259267.

21 Nutbeam , D. (2000) Health literacy as a public health goal: a challenge for contemporary health education andcommunication strategies into the 21

stcentury. Health Promotion International, 15(3):259267.

22 R. I. (2002). H L H P. O H P EB.

://../2.?=&=1&=175

23K, I. (2001). H L: A . H P

I. 16, 289297.

3

.

10, ,

.


14/46

P 14

,24

.

S

. A J25

. T .

24T, K. (2002). H L: N W O B. H E R.17:287290

25 J, K. (2008). H L R P. N S M C.

://..//HL

%20.?=&=INBOX&=&=8386&=4&=HL

%20.


15/46

P 15

FIGURE 4. APPROACHES TO CONCEPTUALIZING HEALTH LITERACY

Approach Focus Description

Functional Health

Literacy

A

S

, ,

, ,

,

, ,

.

Conceptual Health

Literacy

A

,

.

T ,

, , ,

, ,

:

S (..

)

C (..

)

C (..

) C (..

) M (..

)

Health Literacy as

Empowerment

F

,

,

.

S

:

,

,


16/46

P 16

WHY IS HEALTH LITERACY IMPORTANT?

T

:

1. T ;

2. P ;

3. I ;

4. H ;

5. H ;

6. E.

1. THE LARGE NUMBERS OF PEOPLE AFFECTED

A U N E, S C O (UNESCO) I S (UIS) 776 16

.26

A . F 5

(2010) 15

EMRO.27 W

EMRO ,

79 .28

26 UNESCO. (2009). ://..////

//

27 N: T , UIS

, 1995 2005. W

, UIS , J 2002

1995, . I ,

. S ,

. B ,

.

28I

1

.

.


17/46

P 17

F 6 2010 EMRO . I

EMRO Q

UAE.


18/46

P 18

L . F :


19/46

P 19

F A (L 1) N AL S (NALS); 50 L 2.29 P , , .30

A 2,000

U K

.31

60% C ( 16 ) ,

, . I ,

, . 32

S E33, A34, L A

.35

2. RELATED TO POOR HEALTH OUTCOMES

A , ,36

,373839 4041

29 , A, , . (2002)

. 3 . . 201. , D.C.: C E,

.. D E.30I

31N C C (2004). H L: . W S

S L L. L: 2004. A ....

32 ://..///CB3135D3549345FAB8701A3D3ABD6EC4/0/C.

33D E S. T : ,

ICT . L: D E S; 2003,

://...////RR490..

34H A (2006). A B S.

://....//./0/73ED158C6B14BB5ECA2574720011AB83/$F/42

3302006.

35S C (2000) ' . S C, W, CT, USA.

36 PO MK, P RM, G JA, NB LT, R RR. (2005). T

. J G I M ;20:17584.

37B DW, P RM, W MV, C WS. (1998). H . J G

I M ;13:791800.

,

. ,

.

N H: T R H L.

(2005).

(://..//N

HFINAL.


20/46

P 20

.42 A

,

, , ,

.43L . Q

,

.44

I , B

( F 7 ).45

T U S

M 50 80

( , ,

18.9%,28.7%, 39.4%, ). A ,

.

38 W MS, G JA, B DW. (2005). H .A I M;165:194652.

39S RL, Y K, S S, H TB, M KM, S EM.(2006). L : , , . J G I M;21:80612.

40W MV, B DW, P RM, N JR.(1998). R

: . A I

M;158:16672.

41 W MS, D TC, T HH, B PF, P RM.(2006). M

. A J HS P;63:104855.

42W MV, B DW, P RM, N JR.(1998). R : . A I

M;158:16672.

43DW DA, B ND, S S, L KN, P MP. (2004). L . J G IM ;19:122839.

44W MS, D TC, T HH, B PF, P RM.(2006). M . A J HS P;63:104855.

45B, D., W, M., F, J., T, J., G, J., H,J. (2007). H L MAE P. .167(14):15031509


21/46

P 21

FIGURE 7. RELATIONSHIP BETWEEN LITERACY LEVEL AND MORTALITY

( = 3260 M )

H . I , ,

. I

. P

,

,

, .46

3. INCREASING RATES OF CHRONIC DISEASE

T WHO : . C (

) 30% .47 C,

, . I EMRO,

(47%)

.48 O

.

S

. T

,

.49 A : R

46Board on Neuroscience and Behavioral Health, Institute of Medicine. (2004) Health literacy: a prescription to endconfusion. Washington, DC, National Academies Press.

47 W H O. . G, WHO, 2005.

..////( 13 O 2006).

48I

49MG, P. (2005). SM: A B P. P N P:

I C P S M, S 2005.

,

.

.


22/46

P 22

.50

H . I

,

, , ,

, .5152 A

.

T

, ,

.53 L ,

. I 2003, I

M, ,

. I

.54

50 H, C., AC, P., GA J., . (2006). S :

. L, 367, 40411.

51I H I, M

.

52J L, L., A, N., E, L., J, R. & R, K. (2006). A T A I H L R D. H P P, 3.

53NB, L., P, A., K, D. (E, C H L, I M (IOM)).

(2004). H L: A P E C. N A S. W, DC.

54S, B. (2004). H L: A K I M P H. O J I N, F.


23/46

P 23

4. HEALTH CARE COSTS

A

,

. T , , ,

,

. R I

M

. A

,

.55

A U S (

). B

.56

T

US N

U.S. $106 $238 , W

( ),

$1.6 $3.6 57

T

E . 2009.58 T

,

55 I M. (2004). H L: A P E C.

://../?=19750

56B DW, G JA, W MV, S T, P RM, G D, R J, P J. 2002. F

M .

. 92(8): 12781283.

57V, J.A., T, A., R, S., DB, B. (O, 2007). : .

58E, K., W, S., B, U. (2009). T : .

I J P H, ://..//73271816653/.

1 3

.

,

.

C, C. (2007).

.

.

,

.

.

://2...//.


24/46

P 24

2,000 , I 10 N, I, C, B, M, US,

S . W

3 5% . A

US $143 7,798.

5. HEALTH INFORMATION DEMANDS

M 800

. T

.59I , . O,

.60

B . C . .61

, ,

. T 2 , ,

, . T

74

. O, ,

,

. E

, . T

29% .

P

59R, R., A, J., N, C. & O, S. (2007). H : A , R A L L, J. C, B. G & C. S (.), N

C S A L L, V. 7, C S.

60R RE, C T, S R. 2000. A O M P H L A L

I: A A B. R #14. C, MA: N C S A L

L.

61C, C., W, C., W, F., S, D. (2007) B B: P' U U M

J P, A J H B.7;31(S 1):S85S95


25/46

P 25

E

E CD

P

A

L W

C

G

C L

. R

.62

6. EQUITY

A ;

.63

FIGURE 9. FACTORS AND CONDITIONS THAT INFLUENCE LITERACY RATES

A

. F , U K ,

,

.64 T ,

, ,

.65

62S, J. G., A. C, J. V, M. S. W. 2007. "C T P W

L H L: A S P, N, P." A J H B 31

(S 1): S96104.

63R, I., & R, B. (2003) L H C: W W H L W C H

F? ://..////.

64von Wagner, C., Knight, K., Steptoe, A., & Wardle, J. (2007). Functional health literacy and health promoting

behaviour in a national sample of British adults. J Epidemiol.Community Health, 61,

65://...//P/H/H/DH095382


26/46

P 26

V PO

.66 T

:

, ,

.

HOW ARE HEALTH LITERACY AND HEALTH PROMOTION RELATED?

T .67T

, ,

. A

WHO G , "H

,

."68 I ,

, "H

. B '

, ."

T

"

, , ,

"69, U.S. N L M : "

,

".70

A, , . .71 I , :

,

.

.

66V, A., & PO, M. (2007). H , .

A J B. 7(11), 510. ://....//18027287

67

R, S.C. (2001) H : . H P I, 16:207214.

68N, D. (1998) H . H P I, 13, 349364

69P, R.M., B, D.W., W, M.V., N, J.R. (1995) T F H L A:

' . J G I M, 10: 537541.

70US N N L M H P 2010 (2000).

71A, T., (2008). M : , I J PH 53 (2008) 169170

,

,

.

://..//N

HFINAL.


27/46

P 27

. ,

.

I , :

. . ,

,

, ,

. ,

.

.

,

:

,

.

A

5

WHO G C H P, ,

"

,

,

".72

R73 ,

:

H " "74

; H "

",75

;

72

K, I. (2001) H L: . H PI, 16, 289297.

73 R. I. (2002). H L H P. O H P EB.

://../2.?=&=1&=175

74N, D. (2000) H :

21 C. H P I, 15, 259267.

75I

.


28/46

P 28

E ;76

H .77

T " " , , ;78H

";79

H

;80

M

";81

H , ,

.

WHAT MODELS AND FRAMEWORKS EXIST TO DESCRIBE HEALTH LITERACY?

A

(..

) .

M

. I ,

, .

O

I M (IOM) US 2004. B

F 10, IOM

FIGURE 10. HEALTH LITERACY FRAMEWORK US INSTITUTE OF MEDICINE (2004)

76I

77K, I. (2001) H L: . H P

I, 16, 289297.

78I

79I

80I

81I

.


29/46

P 29

I

. T

:82

;

;

A

;

P

;

P

;

A :

.

T C P H A E P83

F 11. T

.

A ,

.

82Parker, R., & Kindig, D. (2006) Beyond the Institute of Medicine Health Literacy Report: Are the Recommendations

Being Taken Seriously? J Gen Intern Med. August; 21(8): 891892http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1831577

83A R, I. & EB, D.(2008). , O: CPHA.


30/46

P 30

FIGURE 11. CANADIAN PUBLIC HEALTH ASSOCIATION EXPERT PANEL MODEL OF HEALTH

LITERACY

G ,

, .84 T

.

84G, D. (2006).


31/46

P 31

FIGURE 12. HEALTH LITERACY FRAMEWORK (GILLIS 2006)

Health

EnhancingOutcomes

Health Promoting

Interventions

Health

Literacy

Basic/Functional

Literacy

Communicative/

Interactive Literacy

Critical Literacy

PersonalEmpowerment

DEG 13/06/06

Provider Practice:e.g. nature of client/provider rel.,communication skills, resources

Health Decisions

Health Actions

Health Advocacy

Health

Outcomes

HealthStatus

Health CareCosts

Social Determinants of Health:

e.g. level of literacy, education, income, ethnicity,employment, age, social support, culture, gender

Situations & Contexts

N

.85 F

:

S

S

E

P

FIGURE 13. CONCEPTUAL MODEL OF HEALTH LITERACY AS AN ASSET (NUTBEAM 2008)

85 N, D. (2008). T . S S & M, V 67, I 12,

20722078 P 2930

A 2009

B, C://..///2009.


32/46

P 32

R U V

F 14.86 T . T

. A G Q :

. .

.

, :

, , , , ,

.87

FIGURE 14. HEALTH LITERACY CONCEPTUAL FRAMEWORK (ROOTMAN, 2009)

86R, I. (2009). H L: W W D A I? P U V,

BC C.

87G, D., Q, A. (2004). T : S .


33/46

P 33

General LiteracyReading ability

NumeracyListening and Speaking ability

Comprehension ability

Negotiation skills

Critical thinking& judgement

Literacy

Workenvironment

Stresslevel

Income

Health

Status

Quality

Of

Life

Lifestyles

Effects of Literacy

Organizational

Development

Communication

CapacityDevelopment

CommunityDevelopment

Actions

Determinants

Use of services

Direct(Medication use,

Compliance,safety practices.)

Indirect

Indirect

Health Literacy

Ability to find, understand and

communicate health informationAbility to assess health information

Other LiteracyScientific, Computer,

Cultural, MediaEtc.

Policy

Education

Early Child

Development

Aging

PersonalCapacity

Living/WorkingConditions

Gender

Culture

HOW IS HEALTH LITERACY MEASURED?

O , ,

.E

88 R E A L M

(REALM), T F H L A (TOFHLA), H A L S

(HALS), N V S (NVS), S I R A C T (SIRACT),

M A R T (MART), L A D (LAD), S

A H L S A (SAHLSA). N

. F , U S A HR Q (AHRQ) C A

H P S ,89 A , 2003 N A A L

(NAAL) J C

.

88 P, A. (2009). M : A .

://...////.

89Agency for Health Care Research and Quality (AHRQ) (2007, Feb. 9, 2007). CAHPS health literacy item set. Retrieved July 16,

2007, from http://www.cahps.ahrq.gov/content/products/HL/PROD_HL_Intro.asp


34/46

P 34

T REALM TOFHLA N

V S . U,

. T . F ,

REALM

.

W

,

. P90

:

(.. ), , ,

( )

A B ,

.91

C : , , ,

. S,

.

A R, H A L S (HALS)

.92B : I ,

, .

N, R HALS .93

A

, , ,

, . A

90 P, A. (2009). M : A .

://...////.

91Baker, D (2006). The meaning and the measure of health literacy.Journal of General Internal Medicine, 21: 878-83.

92R, I. (2009) H L: W ? U V .

93R, I. (2009). H L, W ? P F E

U V. B C C. P C.

.


35/46

P 35

, P,94

:

I

I , ,

(.. , , , ) (.. ,

, , , )

I (

; )

I (

)

I / ,

, , (

)

I

(

)

C

. I ,

,

. C .

WHAT METHODS EXIST TO IMPROVE HEALTH LITERACY?

M

. P , , , , ,

.

94 P, A. (2009). M : A .

://...////.


36/46

P 36

B :

;

;

, ,

;

;

.

T

.

I , . M

, .

T ,

. T ,

A 1. O

.

W

25

?

F

,

US.95 T

.

S

95 R, I., & GEB, D. (2008). : A V H L C. CPHA.

://..////.

'

. "

," . "

." ,

'

' '

. "

,"

.

://..

//2007/0415/4

077.

,

:

, ,

,

,

, .

://..//NHFINAL.


37/46

P 37

,

,

.96

M

, ;97

C . F

,

.98 I ,

, , , ,

, ,

99

A

, . S

. F ,

C C L100 (.., ,, , , ) . T

( )

. C,

.101

WHAT EXAMPLES EXIST IN THE EMRO THAT DESCRIBE BEST PRACTICES AND

LESSONS LEARNED?

W

EMRO . S, :

R

R

96H, J. & E, P. (2006). , : O: E P

H L, C P H A.

97I

98O, F., D, R., D, D., R, J.F. & G, S. (2000). L

N G . M, QC: D

MC.

99B, G., B, C., R, J., G, A., W, S. (2001). W : P .

, 53(12), 16971710.

100C C (2008). : A.

101I


38/46

P 38

R

METHOD

S :

G H

I M WHO E M (IMEMR)

CINAHL (EBSCO)

M (OVID)

PM

G S

A , U N , ,

(NGO)

F : , ,

.102

I E M ,

. A , , ,

. T

,

. T

; ( ),

( ) ( ) .103 T

E M R : , , ,

//, , ,

, , .

OVERVIEW OF FINDINGS

S 1994 2009 : E (2), M, J (4),

P (2), L (2), I, T, Y, P, A I ( A 2). M

(14)

102, B, F, , , (2006). " " . : B C &

C C .

103N , D. (2000) H :

21 . H P I,

15(3):259267.


39/46

P 39

. I

(2) .

T ,104

,105 ,106 ,107A

.108O M P.109 E

,

, (, DVD), ( ),

. T

, , , , ,

( , ), ( )

( ). T

( , , , ,

) , .

T

, , .

SPECIFIC FINDINGS

A , ( )

.

O :

A /

. T A E, 110 ,

: TV ,

104 H C P (2007). C H L C

I R A I E. C I, N 22.

105 J H B S P H: C C P (2005). R

L (RL) L W. ://..///.

106 J H B S P H: C C P (2005). P

YF P. ://..///.

J H B S P H: C C P

107

O, H., C, M., W, L., N, A., & S, M. (2008). P I: C ?. A U B, F H S.

108 H C P (2001). A W S O (AWSO) P H A W

R L. C I, N 13.

109 S, K. (2005). A P. ; 14(2),

167181.

110H C P (2007). C H L C IR A I E. C I, N 22.


40/46

P 40

( )

. E

.

O 111

M H Q (MHLQ). B ,

;

.

T A W S (AWSO) I112 6

. AWSO

( ) . W

, ,

,

, .

A P Y F P 113

, , ,

, , , .

R 1.1 100,000

, . M

42.3 % , 51% 20% TV . Q

, Y F P

.

A J R L L W114

. B

, . R

36% 1997 60 % 2001.

111 S, K. (2005). A P. ; 14(2),

167181.

112 H C P (2001). A W S O (AWSO) P H A W

R L. CI, N 13.

113 J H B S P H: C C P (2005). P

YF P. ://..///.

114 J H B S P H: C C P (2005). R

L (RL) L W.


41/46

P 41

A J T J Y C,115

RH , TV ,

RH

, .

GAPS AND RECOMMENDATIONS

:W I . T . M . D /. O , , . D , .

:N / .W / , , N ( 30 ). C, , . T .

:M (.. ). T

, . S : , .

:T . W , . W , E M .

:M ; , . P USA F. A P, J & J, GSK

115J H B S P H: C C P (2005). J Y

C L: M 1998A M M & C B RH P J Y 19992003.

://..///.


42/46

P 42

, .116

O

. T A R D A

S A, A D I I

, .

T A C

USA. T

40 E S.117

A, HIV/AIDS, , , , , ,

, , , , ,

.

. S USA, A,

J, C, UK .

NEXT STEPS

T 7G C H P N, K O 2630

. F ,

. I,

, ,

. W

,

.

()

I

, . ICT

. T , ,

, , . T

ICT

, /

.

H . A , ,

,

116T P N (2003). ://../.?=44;=319

117I


43/46

P 43

118 . E

. B

, ,

. 119

T ,

. T

.

O

. I ,

. O

, ,

.

C

. T

. D

.

118M, P. (2005) C : . I H,

O. & T,O. () M G C: R C D. N

CLACSO.

119EC (2009). B, C

://..//CB2.?=&=B&=

&=8358&=4&=CB2.


44/46

44

ANNEX 1. MAJOR SYSTEMATIC REVIEWS OF HEALTH LITERACY, BEHAVIOURS

AND OUTCOMES

Pignone, et al., 2005120

Method: Systematic review of research publishedbetween 1980-2003 on the effect of interventions on the

health outcomes of persons with low health literacy.

Included controlled and uncontrolled trials that measured

literacy and examined the effects of interventions for

people with low literacy on health knowledge, healthbehaviours, use of health care resources, intermediate

markers of disease status, and morbidity or mortality.

Findings: Only 5 articles examined the interaction

between literacy level and the effect of the intervention.

Mixed results.

Conclusions: Drawing conclusions difficult because oflimitations in study design, interventions tested and

outcomes assessed. Further research required.

Hauser and Edwards, 2006121

Method: Reviewed research on health literacyinterventions published prior to 2007

Findings: Few rigorous evaluations exist. While mostwidespread initiative used is simplifying reading material

using clear language and pictures, there is no evidence that

this improves health outcomes. Although multimedia

presentations may improve knowledge in both the literate

and the less literate, they do not appear to change health-

related behaviours.

Conclusions: Community development is a promising

avenue that requires more exploration. Creation of

innovative evaluation tools required.

King, 2007122

Method: Review of published and grey literature related

to health literacy interventions in Canada and

internationally. Also conducted key informant interviews.

Findings:

Majority of health literacy interventions to

involve accessing and understanding, with very few

focused on appraising or communicating health

information. Very limited information found on theeffectiveness of health literacy interventions. Some

evidence exists to support the finding and generalunderstanding that a participatory educational and

empowerment approach is effective.

Conclusions:

Barriers to evaluation of programs were

time, money and lack of provider expertise. Further

investigations suggested :

health literacy interventions focused onappraising health information

cultural issues health care professional training

sources of health information

learner and patient perspectives

Clement et al., 2009123

Method: Systematic review of randomized and quasi-

randomized controlled trials that focused on complex

interventions for people with limited literacy or numeracy.

Searched eight databases from 1966 to 2007.

Predominantly North American.

Findings: Knowledge and self-efficacy were outcomes

most likely to improve but not necessarily related tohealth outcomes.

Conclusions: While the review focused on two specific

aspects of health literacy (reading ability and numeracy)

many interventions included wider empowerment and/or

community participation aspects. The implementation of

literacy/numeracy interventions might most usefully be

embedded within this broader approach to health literacy.

120P,M., DW, D., S, S., B, N., & L, K. (2005). I I H O

P L L: A S R. J G I M. 20, 2. 185192

121H, J. & E, P. (2006). , : O: E P

H L, C P H A.

122K, J. (2007). E S I I H L. N C

C D H


45/46

45

123C, S., . . ((2009). C I : A

. P E C. 75, 340351.


46/46

ANNEX 2. STUDIES REVIEWED IN ENVIRONMENTAL SCAN

J H B S P H: C C P (2005).

P YF P. ://..///.

J H B S P H: C C P (2005).

M F P M & C H P, P V S M.://..///.

S, K. (2005). A P. J M H;

14(2), 167181.

H C P (2007). C H L C I

R A I E. C I, N 22.

H C P (2001). A W S O (AWSO) P H A

W R L. C I, N 13.

O, H., C, M., W, L., N, A., & S, M. (2008). P I: C ?. A U B, F H S.

J H B S P H: C C P (2005). J

Y C L: M 1998A M M & C B RH P J

Y 19992003. ://..///.

J H B S P H: C C P (2005).

R L (RL) L W. ://..///.

H C P (2003). M J G I T H

F. C I, N 14. ://..///.

Z, D. (2007). C A HC C C H P:

C I D C A A A P.

://../?=&=%22+++++

+++%22

B, S.A., A, M.A., H, A.A., A, S.M., A, H., B, H.,

B, M., P, S. & R, S.F. (2007). H :

I. J M E D C; 4(1), 19.

health literacy (who)

Documents