HEALTH LITERACY (GESUNDHEITSKOMPETENZ) DEFINTIONEN

The ability to read, understand and act on health-care information.

Center for Health Care Strategies, Inc., 1997

The capacity of individuals to obtain, interpret and understand basic health information and services and the competence to use such
information and services in ways which enhance health.

Joint Committee on National, Health Education Standards, 1998

The cognitive and social skills that determine the motivation and ability of individuals to gain access, to understand and use
information in ways which promote and maintain good health.

Health literacy implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions. Thus, health literacy means more than being able to read pamphlets and make appointments.

By improving people’s access to health information, and their capacity to use it effectively, health literacy is critical to empowerment. Health literacy is itself dependent upon more general levels of literacy. Poor literacy can affect people’s health directly by limiting their personal, social and cultural development, as well as hindering the development of health literacy.

World Health Organization (WHO)
Health Promotion Glossary of Terms, 1998

A constellation of skills, including the ability of individuals to gain access, to understand and use information in ways which promote
and maintain good health.

Ad Hoc Committee on Health Literacy for the Council
on Scientific Affairs, American Medical Association, 1999

The degree to which individuals can obtain, process and understand the basic health information and services they need to make
appropriate health decisions.

(Diese Definition verwendet auch der Institute of Medicine’s Bericht Health Literacy: Prescription to End
Confusion (2004) and the U.S. Department of Health and Human
Services’ Healthy People 2010) National Library of Medicine’s
Health Literacy, Selden, C. et al., 2000

The personal, cognitive and social skills which determine the ability
of individuals to gain access, to understand and use information to
promote and maintain good health. Three levels of health literacy
were identified:
1. basic or functional health literacy;
2. communicative or interactive health literacy; and,
3. critical health literacy

Health Literacy as a Public Health Goal, Don Nutbeam, 2000

The wide range of skills and competencies that people develop to seek out, comprehend, evaluate and use health information and
concepts to make informed choices, reduce health risks and increase quality of life.

Understanding Health Literacy, Zarcadoolas, Pleasant and Greer, 2005

The ability to make sound health decisions in the context of everyday life—at home, in the community, at the workplace, in the healthcare system, the marketplace and the political arena. It is a critical empowerment strategy to increase people’s control over their health, their ability to seek out information and their ability to take responsibility.

Navigating Health: The Role of Health Literacy, Kickbusch, Wait and Maag, 2005

... the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness.

Health Resources and Services Administration

Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.

Health literacy varies by context and setting and is not necessarily related to years of education or general reading ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment. With the move towards a more "consumer-centric" health care system as part of an overall effort to improve the quality of health care and to reduce health care costs, individuals need to take an even more active role in health care related decisions. To accomplish this people need strong health information skills.

The National Network of Libraries of Medicine

These are the skills that all people need to, for instance, find their way to the right place in a hospital, fill out medical and insurance forms, and communicate with healthcare providers.

The Literacy Assistance Center of New York

A constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment

The American Medical Association Ad Hoc Committee on Health Literacy

The wide range of skills and competencies that people develop to seek out, comprehend, evaluate, communicate, and use health information and concepts to make informed choices, reduce health risks, reduce inequities in health, and increase quality of life.

Zarcadoolas, Pleasant & Greer

Health Literacy is the ability to get information, understand it, and use information to lower risk and better health.

Center for Health Literacy at the University of Maryland School of Public Health

... the ability to read, understand, and act on health information.

Pfizer

... a person’s ability to understand and use health information

Communication Health

A measure of a person's ability to understand health-related information and make informed decisions about that information. Health literacy includes interpreting prescriptions and following self care instructions.
McGraw-Hill Concise Dictionary of Modern Medicine

... a shared responsibility between patients (or anyone on the receiving end of health communication) and providers (or anyone on the giving end of health communication. Each must communicate in ways the other can understand."

Health Literacy Consulting, Helen Osborne

Health literacy is the ability to get information, understand it, and use information to lower risk and better health.

University of Maryland Center for Health Literacy

In health promotion practice, health literacy means to understand the conditions that determine health and to know how to change them.

Kickbush 2001

...the set of abilities needed to: recognize a health information need; identify likely information sources and use them to retrieve relevant information; assess the quality of the information and its applicability to a specific situation; and analyze, understand, and use the information to make good health decisions.

Medical Library Association

Health literacy describes the ability of an individual to make decisions and act in favour of their health in daily life - at home, in the community, at school, in the workplace, in the healthcare system, in the marketplace or in the political arena. Being health literate empowers people to increase control over their health, their ability to seek out health information, to navigate complex systems, to take responsibility and participate effectively in all aspects of life.

Health Literacy Alliance, Australia

Health literacyis the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.

Canadian Expert Panel on Health Literacy

Gesundheit:

Ein Zustand vollkommenen körperlichen, geistigen und sozialen Wohlbefindens und nicht allein das Fehlen

von Krankheit und Gebrechen

WHO Constitution, 1948

Kompetenz:

Das ist die Fähigkeit sich den individuellen oder sozialen Anforderungen erfolgreich zu stellen oder eine

Aktivität oder eine Aufgabe zu erledigen.

DeSeCo, 2002

Hinweis: Auf Health Literacy Promotion finden Sie zudem eine ausführlichere Interpretation der verschiedenen Definitionen.

WAS BEDEUTET HEALTH LITERACY (GESUNDHEITSKOMPETENZ)?

Gesundheitskompetenz ist die Fähigkeit des Einzelnen, im täglichen Leben Entscheidungen zu treffen, die sich positiv auf die Gesundheit auswirken.

Healthy People 2010 Fähigkeit des Einzelnen, selbständig grundlegende Gesundheitsinformationen zu finden, zu verarbeiten und zu verstehen und Gesundheitsdienstleistungen zu verwenden, um angemessene gesundheitsrelevante Entscheidungen treffen zu können."[1]

Das „AMA Council of Scientific Affairs“ definiert die funktionelle Gesundheitskompetenz als "die Fähigkeit, den Text von verschriebenen Medikamenten lesen und verstehen zu können, vereinbarte Termine wahrzunehmen, und auch andere gesundheitsrelevante Informationen vom Sinn her zu verstehen, um erfolgreich als Patient zu auftreten zu können.[2]

• Eine Studie bestehend aus 483 Asthma-Patienten fand heraus, dass 60% der Teilnehmer über ein Leseniveau eines Kindes in der sechsten Klasse verfügten und das, obwohl zwei Drittel der Teilnehmer über einen Maturaabschluss verfügten. In Bezug auf das Wissen über Asthma erwies sich die Lesefähigket als einziger starker Prädiktor (~Vorhersagewert). Doppelt so viele Patienten mit einer Lesestärke auf dem Niveau der dritten Klasse hatten eine schlechtere Dosier-Inhalator Technik gegenüber jenen, die über ein High-School-Level (Mittelschule) verfügten (89% vs 48%).[3]

Bei Menschen mit geringer funktionaler Gesundheitskompetenz ist es weniger wahrscheinlich, dass [5,6,7]:

• sie die schriftlichen und Ärzten, Krankenschwestern, Apotheker und Versicherer verstehen.

• sie ausreichen bei den medizinischen Behandlungen mitwirken.

• sie ausreichend in der Lage sind, durch das Gesundheitssystem zu navigieren, um die notwendigen Leistungen zu erhalten.

Menschen mit geringen funktionalen Gesundheitskompetenzen [8,9,10]:

• Erhalten eher Gesundheitsleistungen durch öffentlich finanzierte Programme (Kontrolle der Faktoren wie Alter, Bildung oder sozioökonomischer Status).

• Verursachen häufige höhere Kosten im Gesundheitswesen. Eine Studie der Medicaid-Patienten hat herausgefunden, dass Patienten mit einer Lesestärke auf dem Niveau unter der dritten Schulstufe viermal höhere Gesundheitskosten verursachen als Medicaid Patienten mit durchschnittlichen Lesefähigkeiten.

Mehrere Studien haben gezeigt, dass Personen mit schlechtem Gesundheitszustand überproportional hoch geringe funktionale Gesundheitskompetenzen haben. Zum Beispiel:

• In einer Studie mit 212 Männern mit niedrigem Einkommen wurde festgestellt, dass eine niedrige Alphabetisierungsrate ein besserer Prädiktor als Rasse oder Alter bei fortgeschrittenen Prostatakrebs ist.[11]

• Eine Untersuchung von 182 HIV-positiven Erwachsenen hat gezeigt, dass diejenigen mit geringen funktionalen Gesundheitskompetenz eher Behandlung versäumen als Patienten, bei mit hoher Gesundheitskompetenz, weil eine entsprechende Unklarheit in Bezug auf die vorhandenen Anweisungen besteht.[12]

Quelle: Die Zusammenstellung dieser Informationen erfolgte durch das Center for Health Care Strategies. Sinngemäße Übersetzung durch Alexander Riegler. Weitere CHCS Health Literacy Fact Sheets sind im PDF-Format auf der Seite von chcs (Organisation) abrufbar. Der Link darf hier nicht genannt werden.

Literaturquellen:

1. Healthy People 2010. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.
   

2. Selden C, et al., Health Literacy, January 1990 through 1999. NLM Pub. No. CBM 2000-1. 2000, National Institutes of Health, National Library of Medicine.
   

3. Williams MV, et al. "Inadequate Literacy is a Barrier to Asthma Knowledge and Self-Care." Chest, 1998; 114(4).
   

4. Williams MV, et al. "Inadequate Functional Health Literacy Among Patients at Two Public Hospitals." Journal of the American Medical Association, 1995; 274(21).
   

5. Hopper KD, et al. "The Readability of Currently Used Surgical/Procedure Consent Forms in the United States." Surgery, 1998; 123(5).
   

6. Davis TC, et al. "Knowledge and Attitude on Screening Mammography among Low-Literate, Low-Income Women." Cancer, 1996; 78(9).
   

7. Baker DW, et al. "The Health Care Experience of Patients with Low Literacy." Archives of Family Medicine, 1996; 5(6).
   

8. Gazmararian JA, et al. "Health Literacy among Medicare Enrollees in a Managed Care Organization." Journal of the American Medical Association, 1999; 281(6).
   

9. Weiss BD, et al. "Illiteracy among Medicaid Recipients and its Relationship to Health Care Costs." Journal of Health Care for the Poor and Underserved, 1994; 5(2).
   

10. Address Low Literacy Issues to Improve Medicaid Risk Member Compliance, Reduce Costs. Public Sector Contract Report, 1998; 4(2)
    

11. Bennett CL, et al. "Relation between Literacy, Race, and Stage of Presentation among Low-Income Patients with Prostate Cancer." Journal of Clinical Oncology, 1998; 16(9).
    

12. Kalichman SC, Ramachandran B, and Catz S. "Adherence to Combination Antiretroviral Therapies in HIV Patients of Low Health Literacy." Journal of General Internal Medicine, 1999; 14(5).