With the Australian health system becoming increasingly complex, the need for ‘health literate’ consumers has never been more important. Health literacy stretches beyond an individual’s capacity to complete a form or read a pamphlet. Context matters, as does the ability of individuals to obtain, understand and use healthcare information which promote and maintain good health.
Health literacy influences health, wellbeing and safety, and quality of care. Health literacy is required for access and utilisation of health care, interacting with health care providers and services, and shared decision-making. It is widely reported through the literature that low-level health literacy skills are associated with poorer overall health status and outcomes, decreased capacity to manage chronic diseases, higher rates of hospitalisation and emergency care use, and increased patient costs. Adding to the problem, health professionals can also have low level of health literacy, such as a reduced ability to clearly explain health issues to consumers. Health literacy is cornerstone for providing patient-centred care – it cannot truly be achieved without it.
Despite the well-recognised importance of health literacy, limited Australian data is available. The broad concept is difficult to capture and measure accurately. However the Health Literacy Questionnaire (HLQ) developed by a team lead by Professor Richard Osbourne, offers a critical advance in the measurement of health literacy. Used in many countries and settings, the multi-dimensional tool measures health literacy across nine independent domains to capture the lived experience of health consumers gaining access to, understanding and using information. Additionally, it measures how people manage their health and interact with healthcare providers. Using the HLQ, the Australian Bureau of Statistics (ABS) recently released Australia’s first health literacy data in over a decade, presenting the key indicators from the 2018 Health Literacy Survey (HLS).
Health literacy is the cornerstone for providing patient-centred care – it cannot truly be achieved without it.
So, do Australian health consumers have a healthy understanding?
The new national survey results — grouped into nine independent domains — show Australians generally have a positive view of their own health literacy:
- 96% of people strongly agreed (32%) or agreed (64%) that they felt understood and supported by healthcare providers. (Domain 1)
- 97% of people strongly agreed (23%) or agreed (74%) that they had sufficient information to manage their health. (Domain 2)
- 91% of people strongly agreed (18%) or agreed (73%) that they could actively manage their health. (Domain 3)
- 95% of people strongly agreed (25%) or agreed (70%) that they had social support for health. (Domain 4)
- Just over four in five people strongly agreed (11%) or agreed (72%) that they could appraise health information. (Domain 5)5
- 89% of people found it always easy (33%) or usually easy (56%) to actively engage with healthcare providers. (Domain 6)
- 86% of people found it always easy (26%) or usually easy (60%) to navigate the healthcare system. (Domain 7)
- 88% of people found it always easy (25%) or usually easy (63%) to find good health information. (Domain 8)
- 93% of people found it always easy (39%) or usually easy (54%) to understand health information well enough to know what to do. (Domain 9)
However, those most vulnerable such as people with multiple chronic health conditions or disability, were less likely to have a positive view of their own health literacy. For example, people with a disability or a restrictive long-term health condition were more likely to find it difficult to actively engage with healthcare providers (Domain 6) and less likely to strongly agree that they had social support for health (Domain 4) compared to people who did not have a chronic health condition or disability. Similarly, compared to people who did not have chronic conditions, those with three or more chronic conditions were less likely to strongly agree that they had social support for health (Domain 4), could actively manage their health (Domain 3), and were more likely to have difficulty in actively engaging with healthcare providers (Domain 6)5.
Interestingly, the perceived difficulty of navigating the healthcare system was found to be similar between those with and without a chronic health condition. While those who self-reported very high levels of psychological distress were less likely to find it always easy to navigate the healthcare system compared to those who don’t have such conditions.
These differences were demonstrated through other determinants of health. For example, those who were more likely to strongly agree that they could actively manage their health were: couple-only families compared to those living alone, better educated people compared to lower educated, and those who had never smoked compared to those who smoke daily. Additionally, those who were more likely to strongly agree that they have the social supports they require in managing their health included: households with higher income, couple-only households and couples with dependent children compared to people who lived alone, and people who spoke English at home compared to those who spoke a language other than English at home5.
Furthermore, the survey results highlight some key distinctions between younger and older Australians. For example, people aged 65 years and over reported finding it easier to navigate the health system (Domain 7) and were more likely to always find it easy to actively engage with healthcare providers (Domain 6). However, people aged 18-24 were more likely to strongly agree (39%) that they had social support for health compared to people aged 65 and older (20%) (Domain 4)5.
Overall, survey results show Australian consumers generally have a healthy understanding when it comes to health literacy. However, those most vulnerable in our community were less likely to have a positive view of their health literacy skills. To maximise the future well-being of Australian consumers and the benefits of our health system, a central component of all future health policies and programs should be health literacy and it should be extended to those who need and would benefit more.
 World Health Organization 2009, ‘Health literacy and health behaviour’, WHO, accessed 1 May 2019, https://www.who.int/healthpromotion/conferences/7gchp/track2/en/
 Australian Institute of Health and Welfare 2018, Australia’s health 2018, Australia’s health series no. 16. AUS 221. Canberra: AIHW.
 Johnson, A 2016, ‘Health literacy, does it make a difference?’, Australian Journal of Advanced Nursing, vol. 31, no.3, pp. 39-45.
 Hawkins, M, Gill, SD, Batterham, R, Elsworth, GR & Osbourne, R 2017, ‘The Health Literacy Questionnaire (HLQ) at the patient-clinician interface: a qualitative study of what patient and clinicians mean by their HLQ scores’, BMC Health Services, vol. 17, no. 309.
 Australian Bureau of Statistics 2019, National Health Survey: Health Literacy, 2018, cat. no. 4364.0.55.014: Canberra.