Health Literacy repositioned

I recently read an article on health literacy by Uta Papen: Papen, U. (2009). Literacy, Learning and Health–A social practices view of health literacy. Literacy and Numeracy Studies: An international journal in the education and training of adults, 16(2-1), 19-34. Retrieved from

The dominant view is that health literacy is an ability possessed by individuals (Weiss et al 1995, Baker et al 1999, Nielsen-Bohlman, Panzer and Kindig 2004, Lurie and Parker 2007). It consists of a set of competencies transferable to different contexts. Because health literacy is treated as being context-independent, it is assumed to be measurable through abstract tests. Accordingly, there is much research into patients’ levels of health literacy, this being seen as a prerequisite for developing new tools to teach health literacy. ~(Papen, 2009, p.20).

The measurable idea is an interesting one. There are a lot of research articles that ‘measure’ health literacy. One focus of health literacy research and practice is to look at how medical terms are labeled / described and to make the language used more patient friendly. I think this is a good thing, but it is also a vary narrow aspect of what health literacy is. It only focuses on the basic reading / comprehension aspect of health literacy but does not look at health literacy from the lens of self-advocacy / self-efficacy.

Rather than the dominant (very post-positivist, anything can be measured) view, Papen takes a position on health literacy that approaches health literacy as a practice – and more specifically, a social practice.

The study was grounded in a view of health literacy as social practice. Accordingly, we talked about health literacy ‘practices’ rather than health literacy ‘skills’. Setting aside the notion of skills, we were able to explore what people do with reading and writing rather than to ‘assess’ how good (or bad) they are are what they are doing. This is not to say, however, that we are not interested in people’s abilities. But we did not define these as narrow skills. Rather we conceptualized them as context-bound and changing competencies, some of which, as I will show below, were not located in individuals but in groups and social networks. ~(Papen, 2009, p.21-22).

She takes this one step further, and looks at how health literacy can exist in networks – so not just in the individual. The idea is that when you have a health problem, you don’t just look to yourself for knowledge, sometimes the knowledge you need exists and is shared within your network. Your network is what contains the knowledge you need to make your ‘informed’ decision.

…health literacy is often ‘distributed’. By this I mean that it is not simply a property or an attribute of an individual, but that it is shared knowledge and expertise. It resides in the patient’s social network. An individual’s health literacy could thus be seen as the sum of what she knows and is able to do herself and what she is able to achieve with the support from friends, family and other significant people in her environment. ~(Papen, 2009, p.27)

Reading this brought me back to the connectivist learning theory, and the idea that knowledge can reside within networks, not just within people. One of the principles of connectivist learning learning is that ‘knowledge rests in networks’ – and this distributed definition of health literacy is an example of how knowledge exists within the network.

Prior to reading this example, I didn’t really ‘get’ the connectivist idea of knowledge resting in networks. But now I do. I know first hand how my social networks helped to ‘inform’ my health decisions. I cannot say that one person or even a group of people help to inform the decision – rather it was the network as a whole, together. This too links to concepts of complexity, where the network together is more than just the sum of the parts – it is a thing into and of itself.


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