RESEARCH REFLECTION Health literacy in practice and research

Laura Boland, Dawn Stacey



Health literacy is commonly described as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Malloy-Weir, Charles, Gafni, Entwistle, 2016). Using health literacy sensitive approaches enhances patient engagement and informed decision making, and optimizes health outcomes (Coulter & Ellins, 2007). The World Health Organization provides a broader definition of health literacy: “entails people’s knowledge, motivation, and competences to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the health course” (WHO, 2013). At its core, health literacy implies that a person has the abilities or tools needed to understand information and participate in their health care decisions. Oncology nurses can address patients’ literacy needs in clinical practice and research.

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Bass, P.F., Wilson, J.F., Griffith, C.H., & Barnett, D.R. (2002). Residents’ ability to identify patients with poor literacy skills. Acad Med 77(10), 1039–1041.

Batterham, R.W., Hawkins, M., Collins, P.A., Buchbinder, R., & Osborne, R.H. (2016). Health literacy: Applying current concepts to improve health services and reduce health inequalities. Public Health 132, 3–12.

Berkman, N.D., Sheridan, S.L., Donahue, K.E., Halpern, D.J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Ann Intern Med 155(2), 97–107.

Bonevski, B., Randell, M., Paul, C., Chapman, K., Twyman, L., Bryant, J., Brozek, I., & Hughes, C. (2014). Reaching the hard-to-reach: A systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Medical Research Methodology, 14(42).

Bostock, S., & Steptoe, A. (2012). Association between low functional health literacy and mortality in older adults: Longitudinal cohort study. BMJ, 344, e1602.

Coulter, A., & Ellins, J. (2007). Effectiveness of strategies for informing, educating, and involving patients. British Medical Journal 335(7609), 24–27.

Dewalt, D.A., Berkman, N.D., Sheridan, S., Lohr, K.N., & Pignone, M.P. (2004). Literacy and health outcomes: A systematic review of the literature. J Gen Intern Med, 19(12), 1228–1239.

Durand, M.A., Carpenter, L., Dolan, H., Bravo, P., Mann, M., Bunn, F., & Elwyn, G. (2014). Do interventions designed to support shared decision making reduce health inequalities? A systematic review and meta-analysis. PLoS One, 9(4), 1–13.

Jefford, M., & Tattersall, M. (2002). Informing and involving cancer patients in their own care. Lancet Oncol, 3(10), 629–637.

Kelly, P.A., & Haidet, P. (2007). Physician overestimation of patient literacy: A potential source of health care disparities. Patient Educ Couns, 66(1), 119–122.

Malloy-Weir, L., Charles, C., Gafni, A., & Entwistle, V. (2016). A review of health literacy: Definitions, interpretations, and implications for policy initiatives. Journal of Public Health Policy. epub: 1–19.

Mancuso, C.A., & Rincon, M. (2006). Impact of health literacy on longitudinal asthma outcomes. J Gen Intern Med, 21(8), 813–817.

Pignone, M., DeWalt, D., Sheridan, S., Berkman, N., & Lohr, K.N. (2005). Interventions to improve health outcomes for patients with low literacy: A systematic review. J Gen Intern Med, 20(2), 185–192.

Powers, B.J., Olsen, M., Oddone, E.Z., Thorpe, C.T., & Bosworth, H.B. (2008). Literacy and blood pressure—So healthcare systems influence this relationship? A cross-sectional study. BMC Health Serv Res., 8(8), 219.

Public Health Agency of Canada (PHAC). (2014). Health Literacy. Retrieved from - tabs-2

Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., … Bindman, A.B. (2002). Association of health literacy with diabetes outcomes. JAMA, 288(4), 475–482.

Seligman, H.K., Wong, F., Palacios, J.L., Wilson, C.C., Daher, C., Piette, J.D., & Schillinger, D. (2005). Physician notification of their diabetes patients’ limited health literacy: A randomized, controlled trial. J Gen Intern Med, 20(11), 1001–1007.

Smith, S.K., Zhu, Y., Dhillon, H., Milross, C.G., Taylor, J., Halkett, G., & Zilliacus, E. (2013). Supporting patients with low health literacy: What role do radiation therapists play? Support Care Cancer, 21, 3051–3061.

Stacey, D., Legare, F., Col, N.F., Bennett, C.L., Barry, M.J., Eden, K.B., … Wu, J.H.C. (2014). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews(1).

Sudore, R.L., Yaffe, K., Satterfield, S., Harris, T.B., Mehta, K.M., Simonsick, E.M., … Schillinger, D. (2006). Limited literacy and mortality in the elderly: The health, aging, and body composition study. J Gen Intern Med., 21(8), 806–812.

Wolf, M.S., Gazmararian, J.A., & Baker, D.W. (2005). Health literacy and functional health status among older adults. Arch Intern Med, 165(17), 1946–1952.

World Health Organization (WHO). (2013). Health literacy: The solid facts. Retrieved from


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