Don Nutbeam wrote in “Social Science and Medicine, volume 67, issue 12, in his article “The evolving concept of health literacy”: [*see note below]
“The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots - in clinical care andd in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical “risk”, or a personal “asset”. In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization.”
“The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health.”
The model that we adopted in 1996 when we built a patient centred medical centre assumed that the patient is a partner in the creation and governance of their lifelong medical record and an active participant in the four main processes of their health and care:
1. Immediate care - mainly provided by patients themselves for minor problems and by trained staff for moderate to severe immediate problems
2. Continuing care - provided jointly by trained staff, patients and their families
3. Preventative care - provided mainly by trained staff
4. Public health and health promotion - provided mainly by citizens, their families and friends.
The Donabedian model provides a framework for examining health services and evaluating quality of health care. According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes”. Patient access to records assumes that increasingly the citizen will be health literate and will be a major partner in the four areas of his and public health and care. It assumes that the citizen will have access to the same information and understanding that professionals have.
Modern mobile and information technology exposes citizens worldwide to artificial sensory inputs through radio, television and web media. As Adam Curtis pointed out in his documentary "Centuries of the Self", https://en.wikipedia.org/wiki/The_Century_of_the_Self the first 100 years of radio and television transmission of communication has been monopolised by retailers and sale teams using the early work of Sigmund Freud to engage with basic human hopes and fears. We hope that the next 50 years may see a greater emphasis on personally created health of individuals and of the environment. This will be a culture change of basic assumptions, values, norms and artefacts as pointed out by Ruth Boaden and Samina Munir in the 2001 study "Culture change at Hadfield Medical Centre"
HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data
Email address: richardpeterfitton7 AT gmail.com
[*Note from HIFA moderator (Neil PW): The URL for this 2008 paper is https://www.sciencedirect.com/science/article/abs/pii/S0277953608004577 - restricted access]