2015 Health Promotion Conference. Health Literacy: Research, Policy & Practice

By Milou Fredrix0608_health_promotion

There are 53 different ways of saying, ‘take 1 tablet a day’. This seemed to be the catchphrase of the NUI Galway Health Promotion, 19th Annual Summer Conference held on 18th of June 2015. This year, the conference focused on the research, policy and practice of Health Literacy. Not sure what to expect, I went to the conference open minded, and ready to learn more about this rather novel concept. Armed with my fellow health-psychology colleagues, we marched over to Áras Moyola, where we found ourselves outnumbered by many other disciplines.

Welcoming us and impressing us with the conference programme, Tony O’Brien, Director General of  HSE Ireland kicked off the conference. A good start was learning that health literacy is “the ability to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment.” 

So how did this concept of health literacy come about?

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Dr Rima Rudd, Senior Lecturer on Health Literacy, Education, and Policy at Harvard T.H. Chan School of Public Health.

With her mesmerising way of speaking, the first keynote speaker, Dr Rima Rudd from Harvard T.H. Chan School of Public Health, was able to explain this quite clearly. In the nineties, 20 predominantly developed countries including Ireland participated in national surveys of adult literacy skills. These were in in-depth interviews looking at how well people were able to use everyday materials to accomplish everyday tasks. An example item would be using a bus-timetable to plan one’s journey. When the findings came out, the researchers and participating countries were shocked. It turned out that the literacy skills of the majority of adults in most countries, including Ireland, were not adequate to meet the needs of the current society.

This moment was the beginning of the field of health literacy as people began to wonder if this could have consequences for health. Many research projects were undertaken and results showed strong links between literacy skills and health outcomes. People with limited literacy and numeracy skills have lower adherence to medical regimens, are more likely to be hospitalised, are less likely to make use of screening and report poorer overall health. However, in this talk Dr Rudd highlighted that while these studies show very important findings, there has been a missing perspective to this picture. Health Literacy has kept its eye focussed on the patient. It has been putting the burden of finding, understanding, evaluating and using information on the patient. But literacy does not take place in a vacuum. Researchers have not been focussing on the context in which patients function. We should also be looking at our health system, the communication skills of health care professionals and the availability of information. We need to ensure that health materials are developed and piloted with rigour before they are given to patients.

Dr. Graham Kramer, GP and National lead for self-management and health Literacy in Scotland provided us with a fantastic analogy in the following keynote speech. He reminded us of the first home computers in the early 80’s. As some of us may remember, some serious programming skills were necessary to operate these old-fashioned beasts. Being a toddler at the time, I only seem to remember ‘<Dir> Pacman.exe’. Instead of burdening people with an extensive information or computer skills, companies such as Apple chose to simplify their interface to the point where toddlers can now operate iPads before they can speak. The same should happen with health information.

Dr Kramer highlighted that the key to addressing Health Literacy is not so much to get us to see the world from the perspective of health care but for healthcare to see the world from our perspective. Dr Kramer made us hopeful for change when talking about his work on Making it Easy – A Health Literacy Action Plan for Scotland. It aims to raise awareness of literacy needs, test series of health literacy improvements/ innovations and make successful communication at transitions of care a routine experience in Scotland.

Ms Inez Bailey from NALA- National Adult Literacy Agency then brought us back to health literacy in an Irish context. She highlighted the worrying statistics that about 1 in 6, Irish adults are below level 1 on a five level literacy scale. At this level a person may be unable to understand basic written information. Furthermore, it seems that only 1 in 5 Irish people fully understand the information that they receive from their health care professional. Luckily Ms Bailey stresses that Health Literacy is currently being addressed In the Healthy Ireland (HI) programme. This is a new governmental initiative to improve health in Ireland and it contains the first ever governmental commitment to improving health literacy.

Fig 1: PIAAC [2011]: Ireland Compared to Other Countries

Fig 1: PIAAC [2011]: Ireland Compared to Other Countries

After a quick coffee break to improve our own literacy levels, a series of parallel sessions were offered in which a variety of innovating research was presented. Studies included explorations of health literacy levels in the traveller community, exploring methods to measure health literacy in children, and many more. For a full list of the presented studies, see here.


After a delicious lunch and some time to digest the morning sessions, Dr Geraldine Doyle from UCD spoke about European projects highlighting the importance of health literacy. She particularly stresses that more efficient use of health services and chronic disease management requires improvements in health literacy.

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Dr Joanne Protheroe of Keele University highlights some of the health-related problems associated with low health literacy.

Dr Joanne Protheroe of Keele University subsequently presented her work conducted in Stoke-on-Trent. She found that the majority of patient leaflets in GP surgeries in Stoke-on-Trent would be too complex for 43% of population. Their plan for actions includes getting the community involved to raise awareness of health literacy in front-line staff.

In a following workshop with Dr. Saoirse Nic Gabhainn on engaging with policy makers, large discussion arose about how to best create collaboration, skill-sharing and communication between policy makers and researchers. The idea of a common language and think-tank seemed to dominate.

With a historical overview of Ireland’s Health Policy, Mr Owen Metcalfe, Chief Executive of the Institute of Public Health in Ireland, concluded the conference.

Overall it seems that the message of the day was that health literacy needs to be addressed and improved, but health care managers need to take more responsibility for the problem as well.

  • Health literacy needs to be recognised and linked to patient safety.
  • Institutions need to accept responsibility for making patients understand and for providing accessible information.

Walking back to the Arts Millennium building on this lovely sunny day, we couldn’t help but discuss where we as Health Psychologists come in. Can we collaborate, or is this field passing us by in improving health behaviour? If we enhance health literacy and make materials clearer, will we eliminate all health problems?

To end with Dr Rudd’s wise words:

“Health literacy is not a social and behavioural science, it is not involved in persuasion and it is not changing cultures and norms of health behaviour. Social sciences as psychology are needed to give insight into this. Health literacy focusses on dialog, discussion and dignity of exchange between provider and users of care. It does not necessarily always link to action, but is it a first step. There is dignity in understanding information. Whether or not people choose to do something with this information, is another story.” 

Milou completed a BSc. in Psychology and Neuroscience and a MSc in Health and Social Psychology at Maastricht University in the Netherlands. As part of her masters Milou conducted research on eating behaviour and the underlying psychological mechanisms. As a PhD student at NUI Galway, Milou will focus on ’understanding and managing health-related behaviours within the area of Diabetes’. She is the recipient of a four-year scholarship from the Health Research Board as part of Dr Byrne's HRB Research Leaders Award.

Milou completed a BSc. in Psychology and Neuroscience and a MSc in Health and Social Psychology at Maastricht University in the Netherlands. As part of her masters Milou conducted research on eating behaviour and the underlying psychological mechanisms. As a PhD student at NUI Galway, Milou will focus on ’understanding and managing health-related behaviours within the area of Diabetes’. She is the recipient of a four-year scholarship from the Health Research Board as part of Dr Byrne’s HRB Research Leaders Award.

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