Promoting Health Literacy for People With Disabilities and Clinicians Through a Teamwork Model

Abstract

Introduction Applied health literacy programs are plagued by three fundamental, interconnected problems: (1) lack of a clear, operational definition (Golbeck, Ahlers-Schmidt, Paschal, & Dismuke, 2005; Nielsen-Bohlman, Panzer, & Kindig, 2004; Nutbeam, 2008; Rothman et al., 2006); (2) inconsistent and likely hyperinflation of statistics on the measurement and prevalence of health illiteracy (Yin et al., 2009); and (3) a medical model approach that often fallaciously assumes a low level of health literacy for people with disabilities (Aulagnier et al. The objective of this review and proposed model is to address common communication barriers associated with the medical model approach; this is done by introducing an applied biopsychosocial model of health literacy for people with disabilities that places the patient as a member and leader of the healthcare team. Using an inclusive approach, this model addresses literacy as a communication issue among the individual, health care providers, family, other supports, and accessible health care teamwork environment. The biopsychosocial model presented in this paper is adapted from the International Classification of Functioning, Disability, and Health (ICF; World Health Organization, 2001; Figure 1). The ICF model is unique in that it moves beyond traditional medical models that focus on patient body structures to overall level of functioning and the social, personal, and environmental factors that serve as facilitators or barriers to improved health (Figure 1). This model places the patient at the center of the health model and identifies external factors that prevent the patient from achieving full participation in activities and society. At least one definition of health literacy is " the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions ". This definition can vary considerably based upon the complexity of the patient's health condition, his or her educational level and attitudes, and environmental support factors. Furthermore, family, peers, educational providers, and health care providers need to communicate health care information in a clear, concise fashion. With respect to the latter, the Institute of Medicine (Kohn,