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NURS5002 Health Literacy - 480166032
NURS5002 Health Literacy - 480166032
Introduction
Health literacy is defined by the World Health Organisation as “the cognitive and social skills
which determine the motivation and ability of individuals to gain access to, understand and use
information in ways which promote and maintain good health” (World Health Organization,
1998, p. 10). In terms of practical examples, health literacy can refer to a person’s ability to
understand instructions on prescription medication (Parker et al., 1999), their capacity to find,
interpret and understand health information (Adams, Stocks, Wilson, & Hill, 2009a), and how
well they are able to engage in preventative health behaviours (Canadian Council on Learning,
2007, as cited in Australian Bureau of Statistics [ABS], 2006). It has been reported that up to
59% of Australians aged 15 to 74 years have an inadequate level of health literacy (ABS, 2006);
inadequate being a level which is below the “minimum required for individuals to meet the
complex demands of everyday life and work in the emerging knowledge-based economy”
(Statistics Canada, 2005, as cited in ABS, 2006, p. 7–8). This percentage is alarming because
lower levels of health literacy have been found to be associated with a lack of health knowledge
(Moore, Smith, & Reilly, 2013; Smith, Sullivan, Bauman, Powell-Davies, & Mitchell, 1999;
Williams, Baker, Parker, & Nurss, 1998), poor preventative health behaviours (Adams et al.,
2009b; Lim et al., 2017; Scott, Gazmararian, Williams, & Baker, 2002; van Eijsden, van der
Wal, & Bonsel, 2006), increased risk of chronic disease (Adams et al., 2009b), and higher rates
of hospitalisation (Adams et al., 2009b; Baker, Parker, Williams, & Clark, 1998; Baker et al.,
(Australian Institute of Health and Welfare [AIHW], 2016), as well as a major contributor to
healthcare expenditure (AIHW, 2014). This report aims to explore each of these associations
and justify why health literacy is a significant social determinant of Health in Australia.
Preventative health knowledge
One aspect of health literacy involves knowledge about preventative health. In order to prevent
disease, it is important for people firstly to understand whether a disease is preventable. A study
by Moore et al. (2013) in rural Victoria found that many people underestimated the
preventability of a number of health conditions. Skin cancer was nominated as the most
preventable condition (Moore et al., 2013). Further, lung cancer was considered ‘all or mostly
diabetes by 25.4%, and heart attacks by a 14.7% (Moore et al., 2013). This is in contrast to the
fact that all these conditions are highly preventable through behavioural and screening
measures (AIHW, 2011; Gyárfás, Keltai, & Salim, 2006; Krousel-Wood, Muntner, He, &
Whelton, 2004; Makin, 2011; Rerucha, Caro, & Wheeler, 2018; Schulze & Hu, 2005). Fourteen
years prior to the study conducted by Moore et al. (2013), a similarly low level of knowledge
regarding disease preventability was found by Smith et al. (1999) in the south west Sydney
population. In this study, 61.7% of respondents believed that skin cancer was ‘all or mostly
preventable’; 39.8% for lung cancer, 32.1% for hypertension, 27.8% for cervical cancer, 23.4%
for heart attacks, and 16.7% for diabetes (Smith et al., 1999). Worryingly, many of these
diseases are (or contribute to) the leading causes of premature mortality in Australia (AIHW,
2016). Respectively, heart attacks, lung cancer and stroke were the first, second, and seventh
leading causes of premature mortality (AIHW, 2016). Moreover, hypertension and diabetes are
both established risk factors for heart attacks (Anand et al., 2008) as well as stroke (Goldstein
et al., 2001). It follows; if people are unaware that many of the leading causes of death are
preventable, they are probably less likely to engage in behaviours to prevent them. Moreover,
by analysing the data from Smith et al. (1999) and Moore et al. (2013), it is evident that
Australian’s have poor preventative health knowledge and that it has not improved over time.
Health literacy and preventative health behaviour
Preventative health behaviour involves any activity by a person, undertaken with the intention
to prevent disease or detect asymptomatic disease (Kasl SV & Cobb S, 1966). As an example
of preventative health behaviour, dietary habits are important in the prevention of many health
conditions. Studies have shown that there is an inverse relationship between eating fruit and/or
vegetables and the development of coronary heart disease (He, Nowson, Lucas, & MacGregor,
2007), type 2 diabetes (Carter, Gray, Troughton, Khunti, & Davies, 2010; Liu et al., 2016),
hypertension (Kim & Kim, 2017), some cancers (Aune et al., 2011; Aune et al., 2012; Lunet,
Lacerda-Vieira, & Barros, 2005), and dementia (Loef & Walach, 2012). Worryingly, in 2014–
15, only 49.8% of Australian adults met the recommended daily fruit intake, and only 7.0%
met the recommended daily vegetable intake (ABS, 2015). Linking dietary habits with health
literacy, an Australian study by Lim et al. (2017) found that greater health literacy was
associated with higher intake of fruit and vegetables. In particular, intake was higher in
participants who proactively managed their health and those who had a greater ability to
appraise health information (Lim et al., 2017). These findings in Lim et al. (2017) are echoed
in a study by Reisi et al. (2014) who found that inadequate levels of health literacy were
Many other studies have found an association between inadequate levels of health literacy and
lower levels of preventative health behaviour (Adams et al., 2009b; Parker & Jamieson, 2010;
Scott, Gazmararian, Williams, & Baker, 2002; van Eijsden, van der Wal, & Bonsel, 2006).
Scott et al. (2002) found that those with low levels of health literacy were more likely to have
never had an influenza or pneumococcal vaccine compared to those with higher levels of health
literacy. Further, those with lower levels of health literacy were also less likely to have had a
mammogram in the past 2 years, and more likely to have never had a Pap smear test (Scott et
al., 2002). Another study by van Eijsden et al. (2006) found that a lower level of health literacy
(in this case mainly due to language barrier) was associated with poor knowledge and use of
folic acid supplementations during the periconceptional phase. Research by Adams et al.
(2009b) showed that people with lower health literacy were less likely to engage with
healthcare providers, including general practitioners, specialists, dentists, and allied health
professionals. And finally, a study by Parker and Jamieson (2010) found that Indigenous
Australians with lower levels of oral health literacy were less likely to own a toothbrush; and
for those that owned a toothbrush, less likely to have brushed their teeth in the past day.
Through these examples, and the findings by Lim et al. (2017) and Reisi et al. (2014), a clear
link can be seen between lower health literacy and poor preventative health behaviour.
In addition to low health literacy being associated with less health knowledge and poor health
prevention behaviours, an Australian study by Adams et al. (2009b) found that low health
literacy is associated with an increased risk of chronic disease. In particular, they found that
people with low health literacy were significantly more likely to have diabetes, cardiovascular
Adams et al. (2009b) also found that those with low health literacy were more likely to be
admitted to hospital, particularly those who were older than 65 years. These findings are similar
to research conducted by Baker et al. (1998) and Baker et al. (2002) which found an association
In Australia, management of chronic disease accounts for a large amount of health expenditure
(AIHW, 2014). For example, in 2008-09, out a total health expenditure of $112.8 billion
(AIHW, 2010), an estimated $7.74 billion dollars was spent on cardiovascular disease and
Discussion
Much of the research presented in this report has found an association between health literacy
and a singular outcome (preventative health behaviours, chronic disease and hospitalisation).
In addition to the association between health literacy and each outcome, it is likely that a causal
relationship exists between the outcomes themselves. For example, in the Australian context,
a number of people appear to be unaware about the preventability of many diseases (Moore et
al., 2013; Smith et al., 1999), including cardiovascular disease, lung cancer, and stroke. Many
are also unaware that diabetes and hypertension (both are risk factors for cardiovascular disease
and stroke (Anand et al., 2008; Goldstein et al., 2001)) are preventable diseases (Moore et al.,
2013; Smith et al., 1999). It is highly probable that a lack of this preventative health knowledge
translates into poor preventative health behaviours, for example, less intake of fruits and
vegetables (Lim et al., 2017); which translates further into an increased risk of chronic disease
and hospitalisation (Adams et al., 2009b). In reverse, it follows that improved health literacy
may lead to increased preventative health behaviours such as smoking cessation, engagement
in regular physical activity, and increased consumption of fruits and vegetables; which may
The evidence in this report has demonstrated the important role that health literacy has in
preventing chronic disease, and this is significant because chronic disease is the largest
contributor to premature mortality in Australia (AIHW, 2016) and is also responsible for a
Conclusion
disease, thereby reducing premature mortality and decreasing health expenditure. Thus, health
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Academic Honesty
- All work presented here is my own original work – I have not engaged an online
service, acquaintance, friend, parent, another student, etc. to complete or edit any part
of the assignment
- I have not colluded with, nor copied any part from another student – I have only had
discussions with other students regarding general ideas and the format of the essay
o Further, none of this work has been recycled from a previous assignment
- I have ensured that all the presented information has been attributed to the respective
authors and properly referenced – this includes all data, ideas, phrases, and quotes
o All quotes have been written in quotation marks and have a page number
included – for example – “the cognitive and social skills which determine the
motivation and ability of individuals to gain access to, understand and use
information in ways which promote and maintain good health” (World Health
o All secondary sources also have the primary sourced referenced – For example
Statistics, 2006) and (Statistics Canada, 2005, as cited in ABS, 2006, p. 7–8)
- None of the presented statistics and research findings have been fabricated – for
example:
o All percentages from this excerpt are verbatim from the source – ‘In this
study, 61.7% of respondents believed that skin cancer was ‘all or mostly
preventable’; 39.8% for lung cancer, 32.1% for hypertension, 27.8% for
cervical cancer, 23.4% for heart attacks, and 16.7% for diabetes’ (Smith et al.,
1999)
o Similarly, all values are verbatim from their respective sources – ‘For