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In Chapter 2, we discussed health literacy tools and techniques that can be applied by health professionals working with patients and carers within a clinical environment. These methods tend to be more oriented to improving functional health literacy—achieving better patient understanding and compliance with recommended prevention, treatment and care. Despite the known advantages of shared decision-making, the practical constraints experienced in the clinical environment will often mean that the communication and educational methods we use do not facilitate a high level of interactive communication.
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In this chapter, we examine a range of different community settings that provide opportunities for interventions that are more interactive. These interventions will often have specific behavioural goals but can be delivered in ways that also develop more generic health literacy skills that can be applied in different environments.
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3.2 Health education and health literacy
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Health education improves health literacy. Just as formally organised education is the main route to improved literacy in populations, it follows that organised and structured health education has the potential to improve health literacy. This can be limited to task-based communication—designed to develop specific skills to manage prescribed activities (medication adherence, behaviour change)—but can also be skills based—educational activities that are designed to develop more generic and transferable skills. These are skills that better equip people to discriminate between competing sources of information, adapt to changing circumstances and make more autonomous decisions relating to their health.
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Health education has been an essential component of action to promote health and prevent disease for more than a century. Many campaigns have been and continue to be characterised by their emphasis on the transmission of information, often based upon a relatively simplistic understanding of the relationship between communication and behaviour change. This type of communication campaign may be helpful in improving essential health knowledge and can help improve functional health literacy. This is useful where discrete and relatively simple behavioural changes (such as immunisation uptake) are needed. However, these communications are generally much less successful in influencing more complex behaviour (such as food choices) and rarely achieve sustainable health behaviour change, especially when not accompanied by broader public health policy and regulations. Where health communication campaigns have been found to be effective, these successes have been most observable among the more economically advantaged in the community. They have made little impact on closing the gap in health status between different social and economic groups in society.
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Health education has been considerably strengthened by the development of more sophisticated, theory-informed methods over recent decades. These theories are mainly drawn from social psychology and are not only focused on the transmission of information (though this remains important) but also the development of the personal and social skills that fit with contemporary concepts of interactive and critical health literacy. Consistent with the definition of health literacy in Chapter 1...