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Toward an Integrated Approach to Promoting Health Literacy

Previously in this Space,
I suggested that efforts to promote health literacy are better guided by a salutogenic model that asks, What enables a person to move toward health? or what enables a person to take action for health? That’s true in health promotion. But a person uses the health literacy skill set in various combinations to accomplish different health task in multiple health contexts. No single approach will get us to our envisioned health literate society.
 
Need for an integrated Approach
A new salutogenic perspective and approach to health literacy needs to complement rather than replace the dominant pathogenic approach.  Nearly everyone will at some time find themselves in need of care that only hospitals and healthcare organizations can provide. The pathogenic approach is appropriate and necessary in healthcare contexts.

In addition, with chronic disease/disability steadily increasing and accounting for nearly half of all health loss (Lytton, 2013), and nearly 80% of all health costs in the US (Budenheimer 2009) continuing attention to risk factors and preventive practices is necessary and will remain so. 
 
Still, the number and variety of risks, and the number and variety of conditions that constrain health choices, are so vast that achieving health literacy as defined in the pathogenic model is nearly implausible (Lytton 2013). A salutogenic approach is needed to clarify where, when, and how mothers, and others, can take effective action to achieve, maintain and enhance good health.
 
Domains of Health Literacy
Sorenson et al (2012) integrated the pathogenic and salutogenic approaches represented in 17 definitions and 12 models of health literacy. The authors described three domains of health literacy focused on disease treatment, disease prevention (both pathogenic) and health promotion (salutogenic).
 
Maternal Health Literacy Crosses Domains
A mother uses health literacy skills to function in each of these domains. She functions in the healthcare system when she is an out-patient in prenatal care or oral healthcare, when she is an in-patient in obstetric care, and when she obtains health services for her child. She functions in the prevention domain when she engages  in preventive parenting practices (e.g. using a car seat) and avoids risky behaviors (e.g. smoking). In the health promotion domain, a health literate mother engages in self-care practices (e.g. exercise) and actively supports healthy child development (e.g. reads to the child).  This integrated model is potentially a giant leap for health literacy research. Stay tuned.
 
References
Budenheimer T, Chen E & Bennett H. (2009). Confronting the Growing Burden of Chronic Disease: Can the US Health Care Workforce Do the Job? Health Affairs 28 (1). 65-74. Available online:
 
Sorenson K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, et. al. (2012). Health Literacy and Public Health: A systematic review and integration of definitions and models. BMC Public Health12:80. Available online: www.biomedcentral.com/1471-2458/12/80.
 
Lytton M. (2013). Health Literacy: An Opinionated Perspective. American Journal of Preventive Medicine 45,e35-e40.
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