Gabriella Piscopo

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.

Myth #8: The Myth of Scale

Elephants have bigger brains than humans, but less interconnected and, consequently, less developed (adapted from Morgan 1986). The quest for measurement in health care paved the way for the myth of scale, which ultimately assumes that higher dimensions are associated with better organizational performance. Moreover, it pretends that organizational design is a simple issue, which could be dealt with through reductionism (Gharajedaghi 1999). Organizations are conceived as engines (Morgan 2016): human resources are easily replaceable and performance is predictable (Thietart and Forgues 1995). This approach produces a veil of ignorance, which diminishes the meaningfulness of organizational science. Sticking to this, several scholars have found that organizational dimensions are able to affect organizational performance in terms of efficiency (Chadwick et al. 2004), effectiveness (Sahin and Ozcan 2000), and adoption of innovative technologies (Irwin et al. 1998). However, this reductionist reasoning does not capture the real nature of healthcare organizations.