Health literacy is fundamental to communication between individuals and their health care providers. With advances in information and communication technologies, the way in which health information is created and conveyed directly affects communication. A broader understanding is needed about when and where adults take action to locate, process, and act on health information. Reframing the concept of health literacy to better reflect the full array of literacy skills necessary to function in the current technological environment is particularly important for the growing number of residents in the US who speak little English.
Health literacy, as understood in the US, assumes that English is the primary language used by the individual and the health care system. As a result, language barriers increase difficulties with health literacy. Individuals with limited English proficiency (LEP) may be at greater risk for health problems because of their limited capacity to access, interpret, and use health information presented in English. Drawing on a review of the current literature on health literacy, with a sub-focus on LEP Asian Americans who may particularly have more specific problems in health literacy, this article proposes a new model to address the sources, processes, and outcomes of health literacy for LEP populations in the context of health information technology.
SOURCES OF HEALTH LITERACY AND HEALTH OUTCOMES
Health literacy is defined as 'the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions' (Institute of Medicine of the National Academies, 2004). It is typically recognized that health literacy is generative. Instead of remaining relatively stable over time, health literacy is dynamic, and the associated capacities evolve over the lifespan and are likely to be influenced by health-related, socioeconomic, psychosocial, and cultural factors (Baker, 2006; Derose & Baker, 2000; Zarcadoolas, Pleasant, & Greer, 2005). Core elements of health literacy that allow individuals to function in the health care system have moved beyond reading and numeracy to include a constellation of skills, such as critical thinking, problem solving, decision making, information seeking, and communication (Mancuso, 2009). The Institute of Medicine describes health literacy as the result of multiple, complex social and individual factors (Institute of Medicine of the National Academies, 2004). Individual factors may include education, culture, language, and communication skills. Social factors may consist of educational systems, health systems and the media.
Low health literacy impairs an individual's capacity to function in the contemporary health care environment, and particularly in the patient- physician encounter (Schillinger et al., 2003). Disparities in access to health information, services and technology due to low health literacy can result in less usage of preventive services, less knowledge of chronic disease management, higher rates of hospitalization, and poor self-rated health condition (Berkman et al., 2004). Low health literacy is common in the US, and little improvement in adult health literacy has been observed over time (Berkman et al., 2004; Kutner, Greenberg, Jin, & Paulsen, 2006; Rudd, 2007). In 2004, white adults had the highest rates of health literacy (Berkman et al., 2004), while an estimated 90 million Americans had limited health literacy (Institute of Medicine of the National Academies, 2004). The elderly, ethnic minorities, and persons with low levels of education tend to have low rates of health literacy (Kutner et al., 2006). For example, thirty-one percent of Asian Americans and Pacific Islanders have limited health literacy (Andrulis & Brach, 2007).
LIMITED ENGLISH PROFICIENCY AND LOW HEALTH LITERACY
In the US, adults whose primary language is not English have lower health literacy levels than speakers of English as their native or first language (Institute of Medicine of the National Academies, 2004; Rudd, 2007). …