Addressing Health Literacy and Numeracy Through Systems Approaches

Abstract

Health literacy and health numeracy refer to the skills and competencies that patients use to obtain health information, understand it, and apply it. However, the informatics literature and the patient education literature show that patients’ ability to obtain, understand, and apply health information is strongly influenced by factors other than their individual skills. For example, with poorly designed medication instructions, only high-literacy patients can choose the correct dose, but with well-designed instructions, both high- and low-literacy patients can do so. Clearly, understanding is influenced by not only by patient skills but also by healthcare provider communication skills, the design and accessibility of information resources, and the policies and resources of the healthcare system itself. In this chapter, we describe a distributed cognition model of health literacy and numeracy and demonstrate how it suggests systems approaches for addressing the problem. From this perspective, a patient’s failure to understand health information is always attributable to at least two weaknesses in the system: e.g., limited literacy skills combined with poorly designed information resources. Interventions can then be targeted to strengthen weaknesses at multiple places in the system. Case examples illustrate ways in which this perspective has stimulated effective health informatics interventions to address health literacy and numeracy.