Authors A Peerson and M Saunders
Review Date Jan 2010
Citation Critical Public Health 2009;19:441-456
The term ‘health literacy’ has been in use for about 30 years and reflects the intersection of the fields of literacy and health and refers to: ‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health’ (WHO 1998).
Men’s health literacy and its bearing on health-related attitudes and behaviour are largely absent from discussions on health literacy or men’s health.
To review the literature on health literacy, in particular men’s health literacy, to identify research priorities and raise issues for the development and implementation of evidence-based policies and programs to improve men’s health.
The authors considered various definitions and measurements of health literacy in the international and Australian literature, and discussed the distinction between the broader concept of ‘health literacy’ (applicable to everyday life) and ‘medical literacy’ (related to individuals as patients within health care settings).
The review of the literature showed that men’s health literacy is often submerged within other health research and is rarely the principal research focus. However, findings suggest that men’s health literacy – often under other labels – has a direct bearing on how men value and ‘self-monitor’ their health, decide to seek help and take action (prevention and treatment). In addition to individual factors, men’s health literacy is affected by social class, age, ethnicity and other socio-demographic factors and these factors are often ignored.
Low ‘functional health literacy’ (the ability to read and comprehend health-related materials required to successfully ‘function’ as a patient) has been linked to: higher rates of hospitalisation and increased incidence of chronic conditions; limited effective self-management; and difficulty understanding patient-oriented health literature, medication instructions, clinic appointment cards and hospital signage.
Although there is a large literature on gender and health there has been little attention on the role of gender in health literacy. Notable exceptions are recent studies on ‘mental health literacy’ including an Australian study of young people showing that males are significantly less likely than females to recognise symptoms associated with mental illness and more likely to use alcohol for mental health problems.
Despite a focus on ‘medical literacy’ (a narrow aspect of health literacy) and some gender analysis in terms of men accessing health services, the published evidence consistently reveals the role of gender and dominant concepts of masculinity as key factors that must be addressed to improve men’s health. There are many reports on men’s poor health status and premature death, their reluctance to see a doctor unless unwell and seeking treatment rather than preventive health advice and recognition that men need access to information and education about health. There are also passing references to men’s ‘poor levels of critical health literacy’ but there are no coherent discussions of why it matters or what can be done about it.
To date, men’s health research has largely focused on men’s disengagement and failure to access health care and make healthier life choices. However, there is little understanding of what to do about it and the role of health literacy.
There have been recent calls to bring together the research on masculinity and health to help guide work on men’s health promotion. Ideally, men’s health literacy would find a place in the broader context of initiatives to address men’s health including Australia’s first national men’s health policy. The authors suggest we need to know more about what is required to improve men’s health literacy and potential gains; and how dominant masculinities influence health literacy.
A key question remains: how much difference will improving men’s health literacy make to men’s health outcomes? Alternatively, some in the field pose the question: can men’s health be improved without directly addressing men’s health literacy and what would be the advantage of this?
Considering each component of health literacy – knowledge and information, skills and abilities, and appropriate action – may be helpful in identifying the barriers and identifying where effective gains can be made. There is some suggestion that couching practical health information in a stereotypical ‘male’ context might be successful in improving health literacy although some are concerned about entrenching these male stereotypes. For example, teaching men that ‘being in control’ and ‘independent’ can extend to their own health and successful ageing. These ideas need systematic investigation.
The development of health literacy policies will be facilitated by better evidence on the extent, patterns and impact of low health literacy, and what might be involved in improving it. However, the current lack of consensus of definitions and measurement of health literacy will first need to be overcome.
Points to Note
- Men’s health literacy (the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health, WHO 1998) and its bearing on health-related attitudes and behaviour are largely absent from discussions on health literacy on one hand and men’s health on the other.
- The published evidence consistently reveals the role of gender and dominant concepts of masculinity as key factors that must be addressed to improve men’s health.
- A key question remains: how much difference will improving men’s health literacy make to men’s health outcomes?
- There have been recent calls to bring together the research on masculinity and health to help guide work on men’s health promotion.