Health literacy: a mediator of health behaviour and service engagement
Health literacy is the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health, or that have implications for health.
Health literacy includes the capacity to communicate, assert and enact these decisions.
Health literacy responsiveness describes the way in which services make health information, resources, supports and environments available and accessible to people with different health literacy strengths and limitations.
Recognised global leader in health literacy
We are a recognised global leader in the study of health literacy and the development of health literacy responses.
We led the development of the Health Literacy Questionnaire (HLQ), the Information and Support for Health Actions Questionnaire (ISHAQ), the Ophelia Approach, and the Health Literacy Toolkit for low- and middle-income countries in partnership with the South East Asia Regional Office of the World Health Organisation (WHO).
Ophelia – OPtimising HEalth LIteracy and Access
The Ophelia Approach supports the identification of community health literacy needs and the development and testing of potential solutions. It allows easy application of evidence-based health promotion approaches to the field of health literacy.
The Ophelia Approach involves the collaboration of a wide range of community members, community leaders and workers to develop health literacy interventions based on needs identified within a community.
Each Ophelia project improves health and equity by increasing availability and accessibility of health information and services in locally appropriate ways. The Ophelia Approach has been applied in Australia, Scotland, England, Wales, Thailand and South Africa. It has been applied to improve service pathways (back pain, cancer care, health promotion behaviour), to improve access to health services and in other areas.
Ophelia Victoria is the Ophelia flagship project. It is funded through an Australian Research Council Partnership grant, the Victorian Department of Health and Human Services and Deakin University in collaboration with Monash University.;
The project has partners across eight Victorian health services (local government, community health centres and hospitals). Ophelia Victoria is informing the development of a Health Literacy Response Framework in Victoria.
Please see our paper for more information:
The OPtimising HEalth LIterAcy (Ophelia) process: study protocol for using health literacy profiling and community engagement to create and implement health reform. Batterham RW, Buchbinder R, Beauchamp A, Dodson S, Elsworth GR, Osborne RH. BMC Public Health 2014, 14:694
Cancer services improvement – The Ophelia Grampians project
Initiated in 2014, people at risk of cancer, or who have had a diagnosis of cancer, have been engaged in activities that seek to understand their health literacy and experiences of cancer care. The insights will guide future quality improvement.
This project is a partnership with Ballarat Health Services, Victorian Department of Health and Human Services, Grampian Integrated Cancer Services and the many cancer service providers across the Grampians region of Victoria.
Improvement in uptake of BreastScreen services – Western Melbourne
Initiated in 2015, this project develops strategies to improve the uptake of breast screening and the experience for women in Western Melbourne. We’re working with women from Arabic- and Italian-speaking backgrounds, Aboriginal and Torres Strait Islander backgrounds and lower socioeconomic backgrounds.
This project is a partnership with the Victorian Department of Health and Human Services and BreastScreen Victoria.
Education and training
The Health Systems Improvement team holds workshops and training programs in health literacy including the popular two-day Masterclass.
Other health literacy activities
Our other health literacy activities include:
Health literacy overseas
Several of our studies are looking at the use and adaptation of health literacy measures in different contexts and cultures.
Cultural issues and migrant populations
We’re looking at cultural perspectives and the health literacy strengths and challenges of different cultural groups. Our research includes working with migrants to Melbourne from Somalia, China and India and their interaction with the health and social service system.
Measurements to generate change
We’ve developed several measurement tools that are used globally. By consulting with stakeholders, we’ve created conceptual models based on the real-world experiences of healthcare consumers, practitioners and policy makers.
We've advanced the theory and practice of measurement through shaping the validity-driven approach. The tools developed through this approach are used for epidemiological surveys, evaluation, needs assessment, and to inform intervention development.
Health Education Impact Questionnaire (heiQ)
This questionnaire is now one of the most widely used and robustly validated tools for the evaluation of health education programs. It is used in 19 countries and translated into 9 languages. It is widely used for evaluating individual programs, in national evaluations and also within disease-specific randomised controlled trials.
Measuring the intended outcomes of health education and self-management programs, heiQ consists of 40 questions organised into eight independent scales which measure an aspect of the program:
- health directed activities
- positive and active engagement in life
- emotional distress
- self-monitoring and insight
- constructive attitudes and approaches
- skill and technique acquisition
- social integration and support
- health service navigation.
There are also nine course quality questions that assist course leaders and managers to improve the quality of service delivery. Quality improvement activities and customer experience can be tracked over time.
A licence issued by Deakin University is required to use the heiQ and a fee applies. Please complete the registration form and submit it as instructed on the form. The heiQ administration team will contact you to proceed with your licence request. Upon approval of the licence, you will be provided with the heiQ and supporting documents.
The heiQ is used in many countries by many different kinds of organisations. It has undergone rigorous validation processes in many contexts and settings and is proven to be psychometrically robust.
As well as English, the heiQ (version 3) is available in Bulgarian, Dutch, French (France), Greek, Italian, Norwegian, Portugese (Brazil), Korean, Spanish, and Sinhalese (Sri Lanka). This list is updated as more translations are made.
If you need the heiQ in another language, please ask about our licence to translate the heiQ. All versions of the heiQ, including translations, remain the property of Deakin University, however, particular licence conditions may apply to organisations that assist with translation.
Health Literacy Questionnaire (HLQ)
The HLQ is now one of the most widely used multi-dimensional health literacy assessment tools. It is used widely in Australia, Europe, North America and Asia and has been translated into over 15 languages. It provides a measure of nine health literacy constructs and can be used to measure health literacy with program evaluation, needs assessment, epidemiological surveys and intervention development.
How HLQ works
The HLQ measures the health literacy needs of individuals, groups and populations. It consists of 44 questions organised into nine independent scales. Each scale measures an independent aspect of health literacy and is highly reliable. The nice scales are:
- Feeling understood and supported by healthcare providers
- Having sufficient information to manage my health
- Actively managing my health
- Social support for health
- Appraisal of health information
- Ability to actively engage with healthcare providers
- Navigating the healthcare system
- Ability to find good health information
- Understand health information well enough to know what to do.
The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. BMC Public Health 2013, 13:658
A licence issued by Deakin University is required to use the HLQ and a fee applies. Please complete the registration form and submit it as instructed on the form. The HLQ administration team will contact you to proceed with your licence request. Upon approval of the licence, you will be provided with the HLQ and supporting documents.
The HLQ is used in many countries by many different kinds of organisations. Rigorous validation processes have occurred in different contexts and settings and the HLQ has been proven to be psychometrically robust.
As well as English, the HLQ is available in Arabic, Chinese, Czech, Danish, Dutch, French (France), German, Greek, Hindi, Indonesian, Italian, Malaysian, Portugese (Brazil), Romanian, Slovak, Somali, Spanish (Argentina), Spanish (Spain), Vietnamese and Yoruba (Nigeria).
This list is updated as more translations are made. If you need the HLQ in another language, please ask about our licence to translate the HLQ. All versions of the HLQ, including translations, remain the property of Deakin University, however particular licence conditions may apply to organisations that assist with translation.
Translation, cultural adaptation and measurement adaption
Our unit has vast experience in questionnaire translation. We develop and refine our translation processes through over 70 adaptations to most world language groups to ensure measurement integrity is maintained when tools are adapted to new languages and cultures.
Chronic disease interventions and self-management support
Our research works to create, apply and evaluate chronic disease self-management and education programs. The heiQ is one of the most widely used evaluation tools in the world.
This experience, along with partnerships with peak bodies and the use of intervention development and implementation science, has led to the creation of innovative patient- and provider-centred self-management support.
SteppingUp is a web-based program designed to improve quality of life of people living with long-term conditions. This self-management intervention was co-created with patients, clinicians, non-government organisations and policymakers.
Our evaluation of SteppingUp indicates it has a very strong impact on quality of life, experience of symptoms, mental health and self-management. Current and emerging versions include:
- Musculoskeletal conditions
This is the original version of SteppingUp and was undertaken with funding from beyondblue and in partnership with Arthritis Australia Victoria and Monash University.
SteppingUp has been integrated into a large multi-site cluster randomised controlled trial to improve health outcomes for people living with HIV. This work is being undertaken in partnerships with Monash University within a NHMRC Partnership project.
Funded by the Jean Hailes Foundation, SteppingUp is being adapted to support women managing endometriosis.
- Kidney health
In partnership with Eastern Health, the adaptation of SteppingUp for chronic kidney disease is ongoing.