Health Literacy and Care: much more than health education

Section: Editorial

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Cobo Sánchez JL. Alfabetización en salud y cuidados: mucho más que educar en salud.Metas Enferm jun 2019; 22(5):3


José Luis Cobo Sánchez


Enfermera. Área de Calidad, Formación, I+D+i de Enfermería. Hospital Universitario Marqués de Valdecilla. Santander.


ealth promotion represents an essential element in health policies, and it is a priority (at least in discourse) in health systems. From a holistic approach to health, its promotion allows citizens to control the determining factors involved. Health Literacy (HL) is a multidimensional concept, and currently in evolution; there is impact by different health drivers, both at macro level (sociodemographical, psychosocial, cultural), and individual (individual characteristics, overall literacy, previous personal experiences during health processes and their interaction with the health system) (1). It refers to the ability of individuals to access and use information in order to make health-related decisions. The European Health Literacy Project (HLS-EU) puts forward the following definition: “Health literacy is based on overall literacy, and includes the motivations, knowledge and skills of persons to access, understand, evaluate and apply health information to make decisions on health care, prevention of diseases, and health promotion, in order to sustain and improve quality of life throughout life” (2). This project showed that 58.3% of the Spanish population presented inadequate (7.5%) or troublesome levels (50.8%) of HL, slightly below the European mean level (3). This study showed that in the studied population i, the worse HL levels were significantly associated with a worse perception of health, and with more unfavorable socioeconomic conditions (3).

There is a growing interest about HL by the citizens, due to its impact on health outcomes (an inadequate level is associated with a worse health status, worse preventive habits, and a higher demand in healthcare services, and therefore, a higher cost); and on population ageing and the chronicity derived (improving HL in this group can improve their active involvement, thus improving their independence and quality of life) (4). Different systematic reviews have detected an association between an increase in HL levels and higher levels of empowerment, better skills for decision making, and a more active role in treatment (4,5).

Given the situation in Spain regarding HL, and its impact on the levels of health and wellbeing of the population, it seems necessary to focus on increasing HL levels among the population. This increase will be achieved through measures that go beyond health education for citizens: we must train society to make responsible decisions in terms of health. Achieving this objective, besides involving health agents, will entail commitment by other sectors such as education, the food and pharmaceutical industry, mass media (scientific, as well as the general media that carry out health dissemination), professional and patient groups, and particularly commitment of politicians. Establishing as a priority policy to work the AES of the population to promote health and prevent diseases, involves not only training professionals and patients, but also improving the accessibility and equity of the population, adapting to social and cultural contexts. Therefore, it is necessary to transform traditional health education into better communication with citizens and implement structural measures that favor the adoption of healthy behaviors sustained over time.. We nurses, as health providers, and given our forefront position and our holistic vision, must increase our presence beyond patient care activity, and become actively involved in designing policies and strategies which have an impact on the social determinants of health and the level of literacy among the population. But this change also includes moving towards a less paternalistic health system, which encourages citizen participation.

Versión en Español


Alfabetización en salud y cuidados: mucho más que educar en salud

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1.     Cabellos-García AC, Castro-Sánchez E, Martínez-Sabater A, Gea-Caballero VA. Influencia de la alfabetización en salud sobre la anticoagulación oral: un factor aún desconocido. Aten Primaria. 2018; 50(4):256-7.
2.     Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013; 13(1):948.
3.     Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015; 25(6):1053-8.
4.     Visscher BB, Steunenberg B, Heijmans M, Hofstede JM, Devillé W, van der Heide I, et al. Evidence on the effectiveness of health literacy interventions in the EU: a systematic review. BMC Public Health. 2018; 18(1):1414.
5.     Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess (Full Rep). 2011; (199):1-941.