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Health literacy

The interaction between the skills and knowledge of individuals and the health system.

The Institute of Medicine (2004) describes health literacy as the interaction between the skills and knowledge of individuals and the demands of the health system. Because of the way health systems and services are designed and delivered, consumers face a series of demands on their health literacy. These demands impact on consumers' ability to access health information, care and services. In many health settings there is a significant mismatch between the skills and knowledge needed, and consumers' actual health literacy skills and knowledge.

Health literacy affects people of all ages and socioeconomic status. There are strong links between health literacy and health inequalities (Chao et al 2009; Korhonen 2006). Health literacy affects all aspects of health care – prevention, acute care, long-term conditions and public health.

Changes in the health system, such as the shift to patient-centred care and improved self-management, have put more emphasis on the need for consumers and their families to be responsible for their own health. For this to happen, consumers' health literacy knowledge and skills need to be built. The focus on health literacy needs to extend far beyond improving the written materials given to consumers and their families. Health literacy involves changing the healthcare environment and how knowledge is shared.

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Health care providers and teams are crucial to health literacy 


Providers and teams help to build people's health literacy skills so they can meet the health literacy demands placed on the person. Health teams need to make sure appropriate information is provided to consumers in ways that makes sense to consumers.


Health teams also need to identify and remove any barriers to a person taking action on the new health information they have obtained.

If your team is new to the idea of health literacy,

building awareness and understanding within your team is a critical first step.

The resource section has some influential texts on health literacy

and health-literate organisations which you could circulate and discuss.

Health literacy demands

Health literacy demands are the tasks consumers and families need to undertake to access health services from a health organisation or service. Many of these demands occur within a health service. Others are at transition points such as admissions, transfers to and from services, and discharges, which are relevant because it is here that consumers often lose contact with health services though no one intended it. Because of the way health systems and services are designed and delivered, consumers face a series of demands on their health literacy. These demands impact on consumers’ ability to access health information, care and services.

Examples of health literacy demands are when consumers must:

  • read a letter about a screening programme

  • make a phone call to make an appointment

  • interact with health teams by answering questions, describing symptoms and concerns, providing a history and following instructions

  • read written material supplied by health professionals

  • navigate unfamiliar environments to find health services

  • ask questions about anything they don’t understand

  • check instructions they have to follow.


What is a health literate organisation?

A health-literate organisation makes health literacy a priority. It makes health literacy part of all aspects of its service planning, design, delivery and performance evaluation to reduce the health literacy demands on consumers.​

A health-literate organisation:

  • makes health literacy everyone’s business – leaders, managers, and clinical and non-clinical staff

  • designs systems, processes and services that allow consumers to easily access services

  • supports operational staff to use health literacy approaches and strategies

  • eliminates confusing communication that could prevent consumers from accessing treatment easily

  • actively builds health literacy of consumers to help them to manage their health

  • makes sure operational staff understand that, no matter how high a consumer’s level of health literacy is, stress and anxiety affect their ability to understand and remember new information.


Learn more

A framework for health literacy Ministry of Health, NZ

Three steps to better health literacy – a guide for health professionals HQSC, NZ

Health literacy section Health Navigator NZ 
Six dimensions of a health literate organisation Ministry of Health, NZ 
Building health literate organisations: A health literacy review Ministry of Health, NZ
Understandings of disease among Pacific peoples with diabetes and end-stage renal disease in New Zealand
Association of health literacy and diabetes self-management: a systematic review
Surviving, thriving and resilience NZMJ Digest, NZ
Tofa Saili: A review of evidence about health equity for Pacific Peoples in New Zealand Pacific Perspectives Limited, NZ
COVID-19: health literacy is an underestimated problem The Lancet Public Health, US
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