Logan 2007: Clinical, classroom, or personal education: attitudes about health literacy

Robert Logan, Ph.D. is associated with the Lister Hill National Center for Biomedical Communications, US National Library of Medicine associated with the NIH in Bethesda MD. His paper is a study of attitudes about health literacy among a nonrandom sample, invited from members of the Consumer and Patient Health Information Section of the Medical Library Association and members of the Environmental Health Information Outreach Program at the US National Library of Medicine, thus representing primarily medical librarians and public health policy experts.

The methodology used was something called “Q Methodology” involving a combination of quantitative and qualitative methods. The quantitative part determines “factor arrays” and the qualitative part uses participant’s judgments and their own sorting of their responses according to some scale.

Three “factors” are identified by the study. The first is the opinion that health literacy should primarily be based in clinical settings, between providers and patients, and defines the people seeking health information as patients. This was a more paternalistic model.
Factor 2 was the opinion that health literacy should be carried out in educational settings, primarily the classroom and K-12. These defined the seeker of information as the student.
Factor 3 was the opinion that health literacy is primarily to private individuals, defining seekers of information as consumers who get their information via many sources, but the most important being the mass media. Factor 3 was the most favorable of the three towards critical thinking and patient empowerment vis-a-vis health care professionals and institutions.

The study finds that these three perspectives are to a large extend mutually exclusive and constitute not only the definition of who is to be educated, but what “health literacy” itself is. However, all three seem to agree that health literacy should be promoted in order to better help people make decisions about their own health, but the locus of power in informing and shaping these decisions is different in each case. The brief literature review did not seem to clear up any more precise definition of health literacy beyond this broad consensus.

The narrow restriction of the study to medical librarians does lead to some question as to how important these three factors really are, and how much they are really shared by a wider sampling of both health professionals and the public. However for this very reason the findings indicate interesting future directions for research.