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Center for Health Literacy Promotion Blog

Critical Health Literacy: The mind’s strongest glue?

Previously in this space, we talked about the identified consequences of health literacy. I argued that the documented presence of those consequences in a mother’s (or other’s) life would be evidence that she  possesses and used health literacy skills to produce those consequences.  Now we look specifically at critical health literacy and its consequences.
Nutbeam (2000, 2008) followed literacy scholars Freebody and Luke (1990) to name levels, or, more accurately, categories of health literacy: functional/technical skills (ability to read and use numbers); interactive/social skills (listening, speaking) and critical health literacy, critical thinking skills that enable a person to apply information in new circumstances (Nutbeam 2000) in one’s own life (Kickbush 2001).
While critical skills are commonly considered advanced or higher level skills, some literacy scholars (Charner-Laird, Fiarman, Park, Soderber & Nunes, 2003) have argued that critical  thinking, especially reflection, is so essential to making meaning from information and using it in context, that it should be considered a basic skill. They describe reflection as the “mind’s strongest glue” for making connections essential to understanding any subject.  Maternal health literacy includes all three categories of health literacy skills, which mothers use in various combinations according to the task and the context. Strong skills in one category (say listening and remembering) can compensate for lesser skill in another category (like reading).
Is Critical Health Literacy different from Health Literacy?
Sykes and colleagues (2013) wanted to know if critical health literacy is really different from associated concepts like health literacy and empowerment. So they analyzed the literature on critical health literacy and interviewed UK health literacy experts. They concluded that critical health literacy is indeed a unique concept differentiated from related concepts by its consequences: confidence or self-efficacy,  improved quality of life,  increased social capital, and improved health outcomes.  The unique consequences of critical heath literacy suggest that critical thinking is the active ingredient in health literacy that leads to action and outcomes. This adds weight to our operating theory at Beginnings Guides and the Center for Health Literacy Promotion that reflection is a key lifeskill for mothers taking responsibility for family health.
The Active Ingredient in Health Literacy: critical thinking skills
My friend and colleague, home visiting expert Linda Wollesenhas been saying for decades that mothers make progress when home visitors, parent educators (I’ll add patient educators and health educators) stop giving answers and instead ask questions that make mothers think. In the process of working out answers to reflective questions mothers learn to look objectively, critically at a situation to make sense of it and choose a purposeful response, to formulate their own questions for information seeking, to interpret information and use it for practical purposes in their everyday lives. 
Basic health literacy, described as reading and numeracy skills used to understand basic information needed to make appropriate health decisions (Monday I will quit smoking)  is insufficient to affect outcomes. Action is required for outcomes, often sustained and difficult action. And critical thinking skills are required to plan action, progress in the face of barriers, and produce desired outcomes. So to be health literate, mothers and others need skills in all three categories: functional, interactive and critical health literacy. And the greatest of these is critical health literacy — thinking skills to respond intentionally to the health challenges and opportunities of everyday life.
Nutbeam D. (2000)Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st Century. Health Promotion International, 15, 259267.
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67, 2072-2078.
Kickbush,IS. (2001).Health Literacy: addressing the health and education divide.Health Promotion International 16 (3), 289-297.
Sykes S, Willis J, Rowlands G & Popple K. (2013). Understanding critical literacy: a concept analysis. Biomed Central Public Health:13:150. http:www.biomedcentral.com1471
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