Tell them what they want to know, there must be a benefit for them. Do not tell them something about a new study or what only you think, they should know.

How can I find easy reliable information / internet? How should I speak with my doctor? Can I trust advertising?

Dear Alexander :- This is exactly  what Health Literacy is about  - basic education in the "medical language " : how human body systems work , elementary knowledge about drugs and how they work and even some basical principles of the physians way of thiking, NOT  journalistic medical news about  " breakthroughs " in curing this or that or new potential drugs in development. We know ,  what about should be teached and whwn this will start on in a systematic way we will learn more . This question focuses

more on HOW ? Should we start such  teaching programes for meedle school classes or secondary classes ? Maybe  earler ?  Who are the most indicated teachers  to fulfill this task ? Perhaps biology teachers  or should especially new teachers be prepared ?

Health education should begin at the earliest level and continue. For example, preschool teachers can provide healthy snacks and pass out suggestions to parents about healthy lunches. I recall in the 1980's that some elementary schools would not allow parents to send children in with soda. At the earlier grades, parents could not send in cookies or candy. For middle school, I believe there is actual health education, but I am not sure if it is required. Sometimes the children in the fast-track skip to biology and miss this important opportunity for health education. Teachers in biological sciences should be required to be certified in health education. That would be a start.

Big topic.  I am in agreement that information about health should start in elementary school.  Healthy eating, exercise, health habits like hand washing, cleaning scrapes etc.  While it is necessary to teach children, the parents need to have the same information.  The parents are in charge of the meals, obviously.  Also schools also need to sell healthy foods in the cafeteria.  They could also mark calorie counts for high school children.

Health literacy for adults who have a disease needs much improvement.  The handouts from pharmacies on medications are the same ones given to health professionals.  They are virtually non understandable to a lay person.  Anyone with a diagnosis needs clear, written directions and information about websites that can be helpful.  The Mayo Clinic for example has a wonderful website that is clear and direct and easy to access.  It would be helpful to patients as well as providers.

Bottom line answer, we need face to fact instructions, handouts and internet access to information for patients.

I concur with many of the answers provided thus far regarding the need for early intervention of health education and that this is a vast topic. In addition, as providers of health services, a review of the manner and mode of how we communicate health information requires attention. There are many complexities in health literacy to consider. In a recent research project we began tracking the number of times that education was needed before the desired outcome was achieved.  Repetition, manner, mode and consideration of the caregiver/client dynamics are all components to investigate further.

A very important question relating individuals (health and well-being), organizations (health insurance companies) as well as societies (budgets and policies). 

I totally agree with the view that health education should begin at the earliest possible age, when children start brushing teeth, for example. That's the individual level where parents are requested to intervene. For the general public, we talk about students in kindergarten, schools, and universities, where teachers have to convey relevant knowledge about health aspects that are relevant to the society, in which they live. 

Since health problems and their solutions change over time, a lifelong approach to health literacy is needed. The Internet is a valuable platform to provide information in a comprehensible form (see, for example,  https://www.researchgate.net/publication/262301199_Evidence-Based_Design_Principles_for_Web_Sites_Advancing_eHealth_Literacy?ev=prf_pub). Nevertheless, an important basis for health literacy is information literacy, which empowers citizens to critically evaluate information (e.g. gained over the Internet).

Some more ideas have been posted on this thread here on RG: https://www.researchgate.net/post/Public_fitness_programs-any_new_formats_that_work_in_your_country?_tpcectx=profile_questions).

Article Evidence-Based Design Principles for Web Sites Advancing eHe...

Greeting to everyone to this subject

Health literacy is good for every one. but the literacy and knowing is not enough. I know many persons who have good knowledge and  health literacy. but, they malpractice and did not use the correct and sufficient pill, drug, syrup and  ....

we have good definition for health literacy, good mechanism and good instructions. but, this is not sufficient for healthy manner and good-welling.

we must believe that we need health literacy for having good life. unfortunately, or knowledge and information is not concluded to the believe and behavior.

this is general among all races and ....

you can consider this cite for mutual understanding:

https://www.psychologytoday.com/blog/happiness-in-world/200910/5-steps-changing-any-behavior

please consider this:

The psychology that underlies the changing of behaviors is complex. Two researchers named Prochaska and DiClemente developed a way of describing it they called the Stages of Change Model. Though originally developed in the context of smoking cessation, it's five stages actually describe the process by which all behaviors change.

THE STAGES

1.Precontemplation. In this stage, we've either literally never thought about needing to change a particular behavior or we've never thought about it seriously. Often we receive ideas about things we might need to change from others—family, friends, doctors—but react negatively by reflex. After all, we're usually quite happy with our current stable of habits (if we weren't, we wouldn't have them in the first place). However, if we can find our way to react more openly to these messages, we might find some value in them. Remember, they aren't sent with the intent to harm.

2.Contemplation. Here we've begun to actively think about the need to change a behavior, to fully wrap our minds around the idea. This stage can last anywhere from a moment—to an entire lifetime. What exactly causes us to move from this stage to the next is always, in my view, the change of an idea ("exercise is important") into a deeply held belief ("I need to exercise"), as I discussed in an earlier post, Cigarette Smoking Is Caused By A Delusion (link is external). What exactly causes this change, however, is different for everyone and largely unpredictable. What we think will produce this change isn't often what does. For example, it may not be the high cholesterol that gets the overweight man to begin exercising but rather his inability to keep up with his wife when they go shopping. This is the stage in which obstacles to change tend to rear their ugly heads. If you get stuck here, as many often do, seek another way to think about the value of the change you're contemplating. Remember, it's all about finding and activating a motivating belief.

3.Determination. In this stage, we begin preparing ourselves mentally and often physically for action. The smoker may throw out all her cigarettes. The couch potato may join a gym. We pick quit days. We schedule start days. This mustering of a determination is the culmination of the decision to change and fuels the engine that drives you to your goal. I firmly believe that human beings possess the ability to manifest an unlimited amount of determination when properly motivated by a deeply held belief.

4.Action. And then we start. We wake up and take a power walk. Or go to the gym. Or stop smoking. Wisdom—in the form of behavior—finally manifests.

5.Maintenance. This is continuing abstinence from smoking. Continuing to get to the gym every day. Continuing to control your intake of calories. Because initiating a new behavior usually seems like the hardest part of the process of change, we often fail to adequately prepare for the final phase of Maintenance. Yet without a doubt, maintaining a new behavior is the most challenging part of any behavior change. One of the reasons we so often fail at Maintenance is because we mistakenly believe the strategies we used to initiate the change will be equally as effective in helping us continue the change. But they won't. Where changing a strongly entrenched habit requires changing our belief about that habit that penetrates deeply into our lives, continually manifesting that wisdom (and therefore that habit) requires that we maintain a high life-condition. If our mood is low, the wisdom to behave differently seems to disappear and we go back to eating more and exercising less (this isn't, of course, equally true for all behaviors, especially for addictive behaviors we've long ago abandoned). In a high life-condition, however, that changed belief will continue to manifest as action. When you're feeling good, getting yourself to exercise, for example, is easier because the belief that you should exercise remains powerfully stirred up and therefore motivating. The key, then, to maintaining new behaviors...is to be happy! Which is why it's so hard to maintain new behaviors.

ONE STAGE LEADS TO ANOTHER

The true power of this model really becomes apparent when we recognize these stages are sequential and conditional. In my medical practice, I first identify the stage in which a patient sits with respect to the behavior I want them to change. A smoker who's never seriously considered giving up tobacco would be in the stage of Precontemplation—and if I expected them to jump from that stage over Contemplation and Determination directly to Action, they'd almost certainly fail to change and frustrate us both. If, however, I focus on ways to move them from one stage to the next, I can "ripen" them at a pace with which they're comfortable: from Contemplation to Determination to Action to Maintenance. As an example, I often give patients in the stage of Precontemplation a simple assignment: I ask them to think about how the change I want them to make would improve their lives. That doesn't seem like such a difficult step, but if they do it, I've just moved them into Contemplation! That may seem like insignificant progress, but it's actually 1/5 of the work that needs to be done. Most people (though certainly not all) seem to be more comfortable embracing change in a step-wise fashion.

The utility of the Stages of Change Model isn't restricted to the medical arena but in fact extends to almost every area of life. As an example, my wife used it on me to get me to try sushi (which I now love!). It could be used in business perhaps on employees to yield changes like improved productivity or cooperation, or even on potential clients to get them to hire you! The potential applications are limited only by your imagination.

Finally, and most importantly, you can use this model on yourself. By recognizing which of the five stages of change you find yourself in at any one time with respect to any one behavior you're trying to change, you can maintain realistic expectations and minimize your frustration. Focus on reaching the next stage rather than on the end goal, which may seem too far away and therefore discourage you from even starting on the path towards it.

RELAPSE

The final stage of any process leading to behavior change is one extremely difficult to avoid: relapse. Though it may sometimes be inevitable, if you train yourself to view relapse as only one more stage in the process of change rather than as a failure, you're much more likely to be able to quickly return to your desired behavior. Alternatively, when you allow yourself to view relapse as a complete failure, that assessment typically becomes self-fulfilling. Just because you fell off the diet wagon during a holiday doesn't mean you're doomed to return permanently to poor eating habits—unless you think you are and allow yourself to become discouraged, in which case you will. Long term weight gain or loss, it turns out, isn't correlated to calorie intake on any one day but rather to calorie intake over a period of time, which essentially means if you overeat here or there on a few days only, it won't actually affect your long-term ability to lose weight.

The same is true, in fact, with any behavior you want to change. Never let a few days, or even weeks, of falling back into bad habits discourage you from fighting to reestablish the good habits you want. Always remember: none of us was born with any habits at all. They were all learned, and can all, therefore, be unlearned. The question is: how badly do you really want to change?

Sincerely

Because of increasing in mobile smart phone penetration ratio, using mobile health and personalizing knowledge for specific population is a good choice. It is an innovative approach to address health literacy.

Text messaging is a simple case and mobile smart phone based social networks are advanced interactive platforms.

I think health promoters also need to look at the underlying assumptions they make about educating 'patients' or clients. Often it is not just simply the fact that the 'lay public' need more and more education, but rather that the complexities of their every day lives need to be understood more thoroughly by health promoters. For example, those social determinants of health such as adequate housing, employment and education generally. People should also be given truly informed consent and not just the expert opinion of the day. Healthy eating for example might be easier if 'good' food was really cheap and 'bad' food taxed highly.  Health promoters and the medical fraternity can be too quick to focus on the individual rather than the policy and business imperatives that often make health living harder to achieve for certain communities. Individual education is good to have as well of course and should be presented in creative formats (not just brochures). For example, greater use of social media and interventions that are informed by the audience who is being targeted.

I think health literacy wrt information on the Internet is best addressed through the home and schools at a level at which children are likely to start using the web to inform themselves ie at least at middle school. Learning about health itself is one important aspect, but learning how to determine if information is valid and useful is quite different. The Internet abounds in information purporting to be health information, but in reality may be marketing or even self serving propaganda (eg anti vaccination forums). It is imperative that children learn early, to make a habit of checking the source of the info for reliability and potential biases, to enable use of internet health advice to be useful. This may be best done as part of the basic science skills  taught p.

Schools are good places to start with, but the old people cannot be left out. How much can a kid influence his parents and elders to comply to 'preventive measures' ? We need to burn the candle at both ends to make 'problem' end faster. It is a slow and painful process but it pays off as we will be left with a sustainable 'health literacy'.

There is a lot that can be learnt from Marketing. The way Multi Level Marketing works is by this way. One should aim at converting one person / a small group at a time and creating a leaders / champions for the cause. All you have to do is taking care that the small group of leaders influence the others and also continue to recruit and train other leaders who would carry the chain further.

And some of these leaders need to be influential people in that particular community where you work. It can be a religious leader, social leader, school principal / teacher and the children as well.

Health Literacy should be 'solution' oriented and it should answer the people's question of "why" ? Why they should do / take action to something. What happens if they do not take action. And, most important thing is the cultivation of leaders / champions. Songs, Dramas can help but only when the local people are involved, else it ends up like the fizz in the soda can! Comes out great in the beginning but dies out just as soon.

Peter Pronovost when campaigning for patient safety used to take the mother of the kid who lost his life - which served as an eye opener for him to take great strides in the concepts of patient safety. This strategy is helpful as well.

One person at a time ... that's how these things can go best. Present "readable" and "understandable" data. Incidence of Malaria has incresed by 20% has no meaning to them, but the fact that where 4 out of 10 people were ill earlier now 6 out of the 10 people in their house are affected. And that means loss of pay and time away from work 2 weeks or more. The cost of 'prevention' would be lesser. This is how we can 'buy' them into our schemes of healthcare awareness.

Many healthcare hygiene practices take only compliance and do not cost much money. The benefits are intangible meaning you cannot measure it in terms of 'cost' saved directly but making them understand that they will fall ill less often and thus leading to less days away from work would mean something. WHO insists on technologies / methods that cost less but give tangible benefits even in the field of patient safety. Health Literacy is no different.

To sum it up: Keep the ripples up without letting it die is the key.

Regards,

Dr. Akilesh R

Chennai

drakileshr [at] akilmaxfac [dot] com

Dr. Akilesh, I agree with marketing being our guide. In fact the term 'social marketing' has been coined to explain how infomercials can guide appropriate social behavior for health. Health literacy can be approached much the same way as for the general public. Accountability for action is imperative and cost-effective ways need to be demonstrated.

This is an interesting conversation about health literacy. I personally feel much of the responsibility for educating patients falls on the health care providers. There are many excellent tools to raise awareness of the issues and I though I would share a few here. Pfizer, the pharmaceutical company, has been a huge advocate for Clear Health Communication for years and I applaud their efforts. They have a new tool, A Health Literacy Assessment Tool for Patient Care and Research called the Newest Vital Sign (NVS) available in English & Spanish. It helps providers assess what the patient knows, and then using some of their clear health communication skills (in the link provided) we as health professionals can work to better communicate and get feedback on what the patient understands about their illness and any treatment options we are recommending.

The American Medical Association has a really powerful video on health literacy in America. Watch it to really see what we are missing by not looking for health literacy, it's been around for a while, but wow. (Every time I watch it I am moved by the impact of health literacy on patients.) We should never assume anything, plain language is important and it is not the patient's responsibility to tell us they "don't get it", because they will not. Providers need to think about this issue and I am glad it is being discussed here. There are great resources out there.

http://www.pfizer.com/health/literacy

https://www.youtube.com/watch?v=cGtTZ_vxjyA

Two reference articles from Journal of Pediatric and Patient Education & Counseling discussed about impact of health literacy.

A good way to teach health literacy would be to involve people in health-related decision making. Learning by doing and learning for necessity are surprisingly effective for most topics. Of course it's helpful to provide basic education and monitor health literacy levels. The NVS measure (mentioned above) is based on a nutritional food label - since this involves manipulating words and numbers. Seems a good place to start for me. We also have some work to do making the right information available at the right time. It's probably too hard/expensive to teach information 'search and evaluation'  to everyone (health care workers included).

Tyhank you Andi. I will look for that info.

As for your suggestion : "So we need to find other health literates, wherever they can be found, and have them speak regularly in open forum as often as possible, to teach health literacy and self-advocacy to all ages capable of comprehending." - I am now exploring  if biology teachers are appropriate for assuming the role of teching health literacy in schools.

I wonder is there any benficts to ICT (ex. ePHR) use to improve Helath literacy among patients?

thank you

Please specify what ICT is ( or ePHR ). Anyway  Health Literacy is intended mainly for 

the general public , before they become patients. 

Dear friends and colleagues : Could you please comment the idea to introduce the

subject of  Health Literacy as a part of the sillabus of Biology Education in schools.

This could of course be a solution for the next generation but  it should be examined / evaluated today,

Health literacy--involved clear communication as well as the ability to read medical information, follow directions etc. It is essentially the exchange of health information and when it is not done well, can have deadly consequences for patients. The U.S. National Institutes of Health has information on it (see link). As does Pfizer, a pharmaceutical company that had taken a leadership role in health communication, They have some excellent examples on video that while old, are still relevant even today, as part of their clear health communication tools. Check them out.

http://www.nih.gov/clearcommunication/healthliteracy.htm

Author, I agree that junior high and high school should have a section of a course on health literacy. In fact, most high schools require health as a subject for students that are not taking advanced sciences. I think in health class would be an excellent venue for health literacy. For those students in the advanced college-bound track, we cannot assume that they will develop health literacy. So yes, in biology or earth science - the first major science course should cover health literacy.

Regarding the improvement of health literacy for online patients, I think it is important to integrate the domain knowledge (expert knowledge) into those online health communities. This could be a way when we cannot immediately change the educational level of those patients. So using proper knowledge to lead online patients to a better social group can be extremely useful and specifically, and thus gradually improve their health literacy in their daily life. I am considering to use the UMLS and SNOMED CT, which are best trusted domain knowledge. However, these products could be licensed.