Health literacy policy in Europe: evidence synthesis to identify and learn from best practice.

Problem

Health literacy is the ability to make sound health decisions in the context of everyday life. Low health literacy is associated with lower levels of health, more illness, and earlier death, and is a particular issue for socio-economically disadvantaged and marginalized groups such as migrants, and for those living with long-term health conditions. Changing population patterns due to ageing and migration mean that health systems are under increasing strain. Health literacy is gaining increasing interest from policy-makers as an approach to support people to develop increased competencies for health. WHO Europe commissioned an evidence identification and synthesis of health literacy policies in the 53 member states to enable identification and sharing of best practice.

Approach

The evidence synthesis used clear definitions of policy and of health literacy, and clear inclusion and exclusion criteria. Policies were identified through (i) a rigorous search of peer-reviewed literature using a pre-defined search strategy (ii) an internet search and secondary reference searching for ‘grey’ literature and (iii) a web-based internet enquiry involving health literacy experts. Identified policies were evaluated using (i) known policy analysis frameworks and (ii) a new health literacy policy framework developed iteratively from the analysis. Evidence of impact of the policies on the health literacy of disadvantaged and migrant populations was identified.

Findings

Thirty-nine policies were identified from 17 WHO Europe member states. The member states where policies were identified were in west- and central-Europe. The identified policies included a wide range of antecedents (reasons stated as precursors to the policies), stakeholders (actors involved in the policies and policy beneficiaries), and activities to be undertaken. Evidence of impact from the activities in the policies was identified including both qualitative and quantitative evidence. Of particular interest were those activities based in communities and focused on building health literacy skills in disadvantaged and vulnerable populations such as migrant groups and minority ethnic groups (Sweden, Israel, Ireland), and those with specific health literacy needs, such as people living with HIV (Germany).

Consequences

Policy options have been presented to WHO Europe and the 53 member states. These include the development of region-wide framework to guide the development of comprehensive policies and the identification and engagement of key actors in, and beneficiaries of the policies, and a region-wide information exchange to identify and share good practice. If adopted, these policy options would facilitate the development of more effective policies that support the development of a health-literate Europe, with a focus on those groups with the greatest health literacy need. Activities focused on building health literacy in communities are likely to be particularly effective.