Carmela Annarumma

The Italian Health Literacy Project: Insights from the assessment of health literacy skills in Italy

Inadequate health literacy, namely the problematic individuals ability to navigate the health care system, has been depicted as a silent epidemic affecting a large part of the world population. Inadequate health literacy has been variously found to be a predictor of patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates. However, to date the evidence on the prevalence of limited health literacy is heterogeneous; moreover, studies dealing with this topic show a pronounced geographical concentration. To contribute in filling these gaps, this paper investigates health literacy skills in Italy. Drawing on the European Health Literacy Survey (HLS-EU), a tool to measure self-perceived levels of health literacy was administered to a representative sample of Italian citizens. A stepwise regression analysis allowed to shed light on the determinants and consequences of limited health literacy. Findings suggested that inadequate health literacy is a prevailing problem in Italy, even though it has been overlooked by both policy makers and health care practitioners. Financial deprivation was found to be a significant predictor of inadequate health literacy. Low health literate patients reported higher hospitalization rates and greater use of health services. As compared with the European Countries, Italy showed some peculiarities in terms of health literacy levels and socio-demographic determinants of health literacy, which provide with intriguing insights for policy making.

Contextualizing Health Literacy to Health Care Organizations: Exploratory Insights

Parker, Ratzen and Lurie (2003) pointed out that a silent epidemic is affecting the health status of the American population, namely poor health literacy. Actually, inadequate health literacy is the main cause of the patients’ inability to navigate the health care environment, paving the way for inappropriateness in the provision of care as well as for poor health outcomes. Moreover, it has been esteemed that a third of the European population is not able to properly understand, process and use health information (HLS-EU Consortium, 2012). The same issue has been identified in several Asian countries (see, for example, Nakayama et al., 2015; Pednekar, Gupta & Gupta, 2011). What is striking is that—until today—the attention has been focused on the individual determinants of low health literacy, while studies concerning the organizational health literacy—that is to say, the ability of health care organization to establish friendly and comfortable relationships with the patients—are uncommon (Weaver, Wray, Zellin, Gautam & Jupka, 2012). This article is aimed at exploring the way health care organizations deal with patients living with inadequate health literacy. Drawing on the prevailing literature (Brach et al., 2012; DeWalt et al., 2013; Matthews & Sewell, 2002; Murphy-Knoll, 2007; Stableford & Mettger, 2007) the main approaches to improve organizational health literacy are examined. Then, a distinction between formal and informal tools to address organizational health literacy is suggested and the effectiveness of both of them is compared. The findings of the research suggest that informal tools are more common than formal tools, even though the former have lower perceived effectiveness as compared with the latter. Health care organizations seem to be still far from effectively activating comprehensive organizational health literacy pathways. There is a desperate need for systemic efforts to enhance the awareness of organizational health literacy and to encourage processes of change towards health literate organizational environments.

Empowering organizations to empower patients: An organizational health literacy approach

Abstract Background: Health literacy has been usually discussed as an individual trait, concerning the patient ability to navigate the health care service system. Alternatively, the organizational side of health literacy, or the ability of health care organizations to establish comfortable relationships with patients, has been widely overlooked. This manuscript is one of the first attempts to empirically examine organizational health literacy as a key attribute of health care organizations. Method: A convenience sample of municipal pharmacies operating within the Italian National Health Services was built. Their awareness of organizational health literacy issues and their ability to establish a co-creating relationship with their users were assessed through the Italian version of the Health Literacy Assessment Tool. Three domains were included in the assessment tool: (1) the accessibility of print informative materials used in the pharmacy; (2) the interpersonal communication between the pharmacy staff and the patients; and (3) the sensitivity of the pharmacy staff to health literacy issues. Results: The units of analysis were aware of the impacts of inadequate organizational health literacy on the ability of patients to understand and use health information; however, the organizational commitment to address the needs and the expectations of low health literate patients was limited among the units of analysis. Conclusions: Organizational health literacy is a crucial, but neglected issue among health care practitioners. There is a desperate need for an improvement of health care organizations’ friendliness, which is an essential ingredient in the recipe for patient empowerment.

Paving the way for digital food literacy: A critical review of the literature

The relationship between consumers and food is complex and dynamic. Moreover, different factors have been argued to variously affect the behaviors of consumers when food-related decisions are concerned, including: culture, beliefs, past experiences and knowledge. Food literacy is achieving a growing popularity as a determinant of wise food-related choices. In particular, food literacy could be understood as the individual ability to access, understand, process and use basic food and nutrition information, and to navigate the food system properly. In light of the negative health and social consequences, which are attached to limited food literacy, the enhancement of the individual ability to navigate the food system is crucial to improve individual and collective well-being. To contribute in the enhancement of the knowledge in the field of food literacy, this paper provides a review of the existing scientific literature. A critical approach is adopted to systematize the current understanding of food literacy and pave the way for further developments. Digital tools turn out to be a viable solution to improve individual food-related skills and contribute in wise consumer behaviors. From this point of view, digital food literacy emerges as a key issue inspiring future research in the fields of food education and health promotion.

Exploring the meaningfulness of healthcare organizations: a multiple case study

Purpose Patient empowerment has been variously depicted as a new paradigm inspiring the patient-provider relationship. To the authors’ knowledge, scholars have focused most of their attention on patient enablement. Alternatively, the ability of health care organizations to establish a comfortable and co-creating partnership with the patients has been overlooked. In an attempt to fill this gap, the purpose of this paper is to delve into the meaningfulness of health care organizations, embracing the “organizational health literacy” perspective. Design/methodology/approach In line with the exploratory nature of this research, a multiple case study approach was taken. It concerned three large public hospitals operating within the Italian National Health Service. The meaningfulness of health care organizations was investigated drawing on the organizational health literacy construct. Findings The health care organizations were unaware of several crucial issues to improve their meaningfulness. Problematic organizational health literacy was found to prevent patient involvement and to negatively affect the quality of interaction between the patients and the health care professionals. Practical implications Inadequate organizational health literacy impoverishes the ability of health care organizations to empower the patients and to engage them in value co-creation. The institutional purposes of empowering the patients and involving them in the provision of care require tailored interventions intended to improve organizational meaningfulness. Originality/value This is one of the first attempts to examine the meaningfulness of health care organizations through the lenses of organizational health literacy. Both quality of care and health outcomes are expected to benefit from the enhancement of organizational health literacy.