A New Framework for Health Literacy

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  • This article was downloaded by: [Tulane University]On: 05 October 2014, At: 13:54Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

    Review of CommunicationPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/rroc20

    A New Framework for Health LiteracyChristine SkubiszPublished online: 09 Aug 2010.

    To cite this article: Christine Skubisz (2008) A New Framework for Health Literacy, Review ofCommunication, 8:2, 211-213

    To link to this article: http://dx.doi.org/10.1080/15358590701656197


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  • A New Framework for Health LiteracyChristine Skubisz

    Zarcadoolas, C., Pleasant, A. F., & Greer, D. S. (2006). Advancing health literacy:

    A framework for understanding and action. San Francisco: Jossey-Bass. 368 pp.

    ISBN: 9780787984335. $50.00.

    Advancing Health Literacy: A Framework for Understanding and Action, by Christina

    Zarcadoolas, Andrew F. Pleasant, and David S. Greer, examines the role of

    communication in the health literacy crisis the United States is facing. Examples of

    recent campaigns and detailed definitions make this book easy to read and useful to a

    large audience of readers. Practitioners who are well aware of the literacy issue are

    offered a framework for action and academic scholars are presented with practical

    applications for their research. The text provides a synthesis of theory and practice

    that is often missing in the communication discipline.

    A New Model is Proposed

    The authors begin by defining health literacy and provide a context for this important

    public health issue. Most importantly, a multidimensional model of health literacy is

    offered. According to the authors, health literacy is an integration of four domains:

    fundamental literacy (including knowledge of reading, writing, speaking, and

    numeracy), scientific literacy (the skills and abilities needed to understand science

    and technology), civic literacy (awareness of public issues and participation in critical

    dialogue), and cultural literacy (ability to understand the beliefs, customs, and

    worldviews of diverse individuals). These components are combined to provide a

    model for improving health communication and education.

    A historical context is given in Chapter 2 that includes a brief history of public

    health, including health promotion and advocacy. The next three chapters address

    specific communication components including how language works, an introduction

    to the mass media, and the role of the Internet. Examples of Internet use during

    Hurricane Katrina, the recent surge of direct-to-consumer pharmaceutical sales, and

    communication about the avian flu provide apt illustrations of key concepts. The

    Christine Skubisz is Ph.D. student at the University of Maryland. Correspondence to: University of Maryland,

    Department of Communication, 2130 Skinner Building, College Park, MD 20742-7635, USA. Email:


    ISSN 1535-8593 (online) # 2008 National Communication Association

    DOI: 10.1080/15358590701656197

    The Review of Communication

    Vol. 8, No. 2, April 2008, pp. 211213




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  • critical task of communicating accurate and accessible information to the public is


    In the second section of the text, six case studies are presented, including: prenatal

    care, the 2001 anthrax terrorism threat, genomics, the Massachusetts Tobacco Control

    Program, HIV/AIDS, and diabetes in the Native American population. Each case

    study exemplifies one of the four components in the proposed health literacy

    framework: fundamental, scientific, civic, and cultural literacy. These case studies

    provide excellent examples of effective health campaigns, illustrate the multi-

    dimensional nature of health literacy, and provide support for the framework

    suggested by the authors.

    The authors conclude with a chapter on program evaluation and guidelines for

    advancing health literacy. A case study of World Educations Breast and Cervical

    Cancer Project is used to illustrate the components of effective evaluation of health

    programs. While the importance of evaluation is stressed, the text only provides a

    cursory overview of the evaluation process. This is helpful for readers who are new to

    qualitative and quantitative evaluation. However, readers with more advanced

    knowledge will learn nothing new. In this final chapter, 11 guidelines for advancing

    health literacy are presented. These universal guidelines are designed to help

    individuals who communicate health information incorporate the principles of

    health literacy in their programs or campaigns. The authors provide suggestions for

    selecting clear and understandable vocabulary, choosing sentence length and

    complexity, field-testing messages, web design, layout of print materials, and

    successfully using the media.

    Usefulness for Students, Researchers, and Practitioners

    This book is most valuable for readers who are not familiar with the concept of health

    literacy. The authors provide a basic overview of what health literacy is, why it is

    important, and examples of when it has been implemented effectively. The most

    important contribution of this work is the multidimensional model of health literacy

    that it offers. This is a clear framework that is easy to understand and is useful for

    researchers and practitioners alike. The authors contend that researchers need to

    adopt and articulate a more comprehensive understanding of health literacy. This

    framework allows for a more complete definition of the construct. The best measures

    of health literacy currently available do not address the multi-dimensional nature of

    the construct. The authors call for the development of improved measures, providing

    an agenda for future research. The four domains suggested in the text expand the

    definition of health literacy tremendously and will aid in the construction of

    improved measures. I am hesitant to call this framework a model, as it is referred to

    in the text. A model implies a complete, theory-based framework that is testable

    through research. The health literacy framework presented by the authors is a useful

    starting point but, as they point out, a great deal of work is still needed in this area of


    212 C. Skubisz




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  • In addition, Advancing Health Literacy: A Framework for Understanding and Action

    can be used as a teaching tool for health communication students. While this book

    can be used as a textbook, the fact that it does not read like one is a benefit.

    Considered as a textbook, it would be very appropriate for an undergraduate health

    communication course or campaign design course. The authors provide summaries

    at the end of each chapter for students and exercises that instructors can use for class

    discussions or assignments. Glossaries of key terms and summary boxes within the

    chapters are also included to make the book reader-friendly. The book could also

    serve as an excellent complement to more traditional communication textbooks. The

    authors provide real-life applications of basic communication principles. This text is

    best suited to a beginning student. The material included in this text is too

    rudimentary for an advanced communication student or scholar, and much of the

    material presented is not new. The authors address theory in broad and general

    terms. Traditional communication theories are glossed over or missing all together.

    Those in the discipline have long been aware of the suggestions for successful

    communication put forward by the authors, including audience analysis, appropriate

    message design, and program evaluation. However, I think that it is important to

    reinforce these recommendations in the context of health literacy as these authors

    have done. This book brings the public health and communication disciplines

    together in a practical manner that makes sense. To their credit, the authors do not

    portray communication as an obvious or secondary feature in health campaign

    design. Effectively communicating health information is not an easy task, and the

    authors present an accurate picture of this challenging process.

    Framework for Health Literacy 213




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