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How Health Literacy Research Can Address Health Disparities

October is Health Literacy Month. To celebrate, we will be posting a series of research highlights and interviews discussing health literacy research and practices throughout the month.

Health literacy relates to people’s knowledge of issues relating to their health and well-being, as well as their ability to increase their understanding. It impacts patient access to healthcare, understanding of health conditions, and practice of lifestyle factors that may prevent health conditions from arising in the first place. Fundamentally, health literacy not only empowers people to take an active role in managing their own health, but can also enable them to participate in social initiatives to improve global health.

Differences in health literacy also impact on health disparities, and equity of experience in healthcare systems. As part of PLOS’ commitment to Diversity, Equity and Inclusion, we aim to increase the publication of research that studies inequalities, racism, and inequities facing minority or marginalized populations. Therefore, PLOS ONE is excited to serve as an Open Science platform for the publication of health literacy research that is immediately available to the widest possible audience.

We have a number of Editorial Board Members with expertise in health literacy ready to assess your research; watch out for our upcoming interviews later this month with Dr. Enrique Castro-Sanchez (Brunel University London) and Dr. Opeyemi Babatunde (University of Keele), who will be discussing health literacy at PLOS ONE, and their own research on this topic.

This week, we are revisiting five articles recently published in PLOS ONE that touch on different aspects of health literacy research. They range in scope from improving young people’s knowledge of mental health issues to assessing people’s ability to understand graphs, but they are united in emphasizing the importance of health literacy for improving health and achieving equitable outcomes.

Are graphs harder for some patients to understand than tables?

StockSnap, Pixabay

Data visualization is a hot topic, and scientists are keen to find innovative graphical methods to present complex information effectively. However, Durand and colleagues point out that there is limited research about graph literacy among people with lower education and socioeconomic status. Using a cross-sectional survey, they found that graph literacy scores were low among 436 people in the US on Medicaid, and that comprehension scores were actually slightly higher for tables than bar graphs and icon arrays. These findings have important potential implications for how clinicians and public health organizations communicate health information to patients.

Health literacy is not just important for physical health

victoruzihben, Pixabay

There is increasing recognition of the importance of mental health for overall health and wellbeing. Mental health literacy interventions can help improve recognition, to support help-seeking and management of mental illness. In this study, Jumbe and colleagues describe findings from focus group discussions with young people in Malawi. The study forms part of an initiative to inform cultural adaptations of an existing mental health literacy tool, to support development of an online curriculum for university students in Malawi. Themes identified include poverty-related health challenges, relationship issues, and lack of dialogue about and support for mental health.

Increasing participation of racial and ethnic minorities in clinical trials

janeb13, Pixabay

Participation in clinical trials by people from racial and ethnic minorities is essential to help reduce health disparities. However, distrust in clinical institutions as a result of racism and discrimination has limited participation to date. Health for All is a website designed to help people learn more about clinical trials, and enhance participation of minority communities. Simon and colleagues describe the development of the tool across seven iterative design sessions, as well as usability testing by patrons of libraries attended by underserved communities in Chicago.

Low health literacy widens health inequities

RazorMax, Pixabay

People with lower socioeconomic status are more likely to suffer from multi-morbidities, and have subsequent greater difficulties with self-management of their conditions. In a systematic review by Woodward and colleagues, financial constraints and health literacy, including poor communication from health professionals, were identified as socioeconomic barriers to self-management of multiple long-term conditions. These barriers can further contribute to the widening of health inequities experienced by patients.

Health literacy and self-management of multi-morbidities

Department of Foreign Affairs and Trade, CC BY 2.0

Yadav and colleagues undertook a cross-sectional study to examine levels of health literacy and patient activation among patients with multi-morbid chronic obstructive pulmonary disease (COPD) in Nepal. They found low levels of both health literacy and patient activation among participants. They also found that lower health literacy scores were associated with participants with no education, from Indigenous communities, with a family income less than USD176, and women. The findings are being used to design a COPD self-management program for patients with low health literacy.

Cover image by Freepik


Durand M-A, Yen RW, O’Malley J, Elwyn G, Mancini J (2020) Graph literacy matters: Examining the association between graph literacy, health literacy, and numeracy in a Medicaid eligible population. PLoS ONE 15(11): e0241844.

Jumbe S, Nyali J, Simbeye M, Zakeyu N, Motshewa G, Pulapa SR (2022) ‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy intervention. PLoS ONE 17(3): e0265530.

Simon MA, O’Brian CA, Tom L, Wafford QE, Mack S, Mendez SR, et al. (2021) Development of a web tool to increase research literacy in underserved populations through public library partnerships. PLoS ONE 16(2): e0246098.

Woodward A, Davies N, Walters K, Nimmons D, Stevenson F, Protheroe J, et al. (2023) Self-management of multiple long-term conditions: A systematic review of the barriers and facilitators amongst people experiencing socioeconomic deprivation. PLoS ONE 18(2): e0282036.

Yadav UN, Lloyd J, Hosseinzadeh H, Baral KP, Bhatta N, Harris MF (2020) Levels and determinants of health literacy and patient activation among multi-morbid COPD people in rural Nepal: Findings from a cross-sectional study. PLoS ONE 15(5): e0233488.

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