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Health literacy: a necessity for increasing participation in health care.

Current UK government policy places much emphasis on increasing patient participation in health care, stressing that access to better information is required to support patients' participation and to enable them to make choices in their own health care.1 Patient participation has great practical value in achieving better health outcomes among those who actively participate in healthcare decisions compared to those who do not.2 Previous studies have shown that patients are not currently involved to the degree that they would prefer,3 and that this desire for engagement is consistent regardless of social background and educational status.4

Those who currently participate in healthcare decision making tend to be younger, female, educated, articulate patients of higher socioeconomic status.5 While the range of methods for patient communication in clinical settings has grown, most are dependent on higher levels of literacy and numeracy. There is relatively little published evidence concerning attempts to encourage people from lower literacy backgrounds to make informed health decisions through the use of different types of decision support materials or approaches.6,7

Differences in literacy and numeric skills lead to marked variation in an individual's ability to obtain relevant health information, and in their opportunity and capability to apply that information in interactions with health professionals and services.8 It follows that without careful implementation, current government policies may inadvertently exacerbate existing inequalities in health by favouring those already advantaged as a consequence of their education and basic skills.9 It is possible that this is one of the reasons why, despite an overall increase in health in the UK population, the ‘inequalities gap’ between the most and least advantaged in society is widening.10

Functional literacy (the ability to read simple text and write simple sentences about everyday life), is a basic skill …