In its landmark report, Health Literacy: A Prescription to End Confusion (IOM, 2004), the Institute of Medicine1 noted that there are 90 million adults in the United States with limited health literacy who cannot fully benefit from what the health and health care systems have to offer. This report also stated that “improving individual health literacy requires great effort from the public health and health care systems, the education system, and society overall” (IOM, 2004, p. xiv). Since the release of that report, health literacy has become a vibrant research field that has developed and disseminated a wide range of tools and practices that have helped organizations ranging in size from large health care systems to individual health care providers and pharmacists to engage in health literate discussions with and provide health literate materials for patients and family members. Improving the health literacy of organizations can be an important component of addressing the social determinants of health and achieving the triple aim of improving the patient experience, improving the health of populations, and reducing the cost of care. However, the focus on organizations does not address the larger issue of how to improve health literacy across the U.S. population. Realizing that goal requires a larger effort, one that addresses health literacy at the community and population levels. To get a better understanding of the state of community-based health literacy
1 As of March 2016, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine continues the consensus studies and convening activities previously carried out by the Institute of Medicine (IOM). The IOM name is used to refer to publications issued prior to July 2015.
interventions, the Roundtable on Health Literacy hosted a workshop on community-based health literacy interventions. This workshop, organized by an ad hoc planning committee (see Box 1-1), was held on July 19, 2017. It featured examples of community-based health literacy programs, discussions on how to evaluate such programs, and the actions the field can take to embrace this larger view of health literacy. To help inform the discussions at the workshop, the roundtable also commissioned a review of community-based health literacy interventions and their outcomes that have been reported in the literature (see Appendix C).
An independent planning committee organized this workshop in accordance with the procedures of the National Academies of Sciences, Engineering, and Medicine. (See Appendix A for the workshop agenda.) The planning committee’s members were Steven Teutsch (Chair), Laurie Francis, Romana Hasnain-Wynia, Andrew Pleasant, and Earnestine Willis. This publication summarizes the workshop’s presentations and discussions, and it highlights the reactions to the proposed framework from a broad range of stakeholders, which will inform preparation of the roadmap for integrating health literacy, cultural competency, and language access services into a revised measurement framework. Chapter 2 discusses the methods used to conduct the commissioned literature review and the results of that review. Chapter 3 describes several community-based health literacy programs and Chapter 4 focuses on the issues and challenges in evaluating community-based health literacy programs. Chapter 5 recounts a moderated discussion
on where the field needs to go in the future, and Chapter 6 summarizes the roundtable members’ reflections on the day’s discussions.
In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. This Proceedings of a Workshop was prepared by workshop rapporteur Joe Alper as a factual summary of what occurred at the workshop.