Health literacy: an exploratory bibliometric analysis, 1997–2007

Abstract

As defined by the American Medical Association Foundation, health literacy is a “patient's ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment” [1]. The 2003 National Assessment of Adult Literacy (NAAL) has identified three types of literacy: prose, document, and quantitative [2]. Prose literacy—the ability to read and comprehend uninterrupted or parenthetical text (patient instructions)—and document literacy—the ability to search, read, and comprehend noncontinuous text (food and drug labels)—both come into play when decoding health information [3]. NAAL research found that approximately 14% of adults in the United States read at the “below basic” prose literacy level and 12% of adults read at the “below basic” document literacy level [4]. The NAAL also added a health literacy section to the 2003 assessment that measured adults' ability to perform health-related reading tasks, such as following doctors' instructions or reading medicine labels. The assessment found that 37% of adults had “basic” or “below basic” health literacy levels and that these scores generally tended to increase with educational levels attained [3]. Low health literacy skills can lead not only to poor self-care, but inadequate care from physicians if patients cannot describe their symptoms or recall medications accurately. These problems can be decreased with more sensitivity to a patient's literacy level, more abundant and easier to understand health education, and outreach by the medical community. The inability to read and process health information is a matter of grave importance, not only to the patient, but to the state of public health. The medical community has recognized health literacy as a pressing concern and has published the bulk of the scholarly literature on this topic; however, the study of health literacy can include research from disciplines such as adult literacy, nursing, social science, and education. Retrieving comprehensive information covering all aspects of health literacy can present a challenge. A search of the scholarly literature produced one previous bibliometric study of health literacy, but it was limited to PubMed and its purpose was to indicate possible gaps in health literacy scholarship in the European Union [5]. Alpi's 2005 bibliometric analysis examined the publication patterns of health literacy journal articles in public health from nine databases from a variety of disciplines to document the increase in scholarship on the subject, its core or most productive journals, and relevant databases where literature could be found. The analysis also supported the need for a greater awareness of a wider variety of available databases for information retrieval on multidisciplinary topics [6].