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7 patients really understand? Nursing Economics 2002;20: ) Kickbusch IS. Health literacy: addressing the health and education divide. Health Promotion International 2001;16: ) Davis TC, Williams MV, Marin E, et al. Health literacy and cancer communication. Ca: a Cancer Journal for Clinicians 2002;52: ) Davis TC, Dolan NC, Ferreia MR, et al. The role of inadequate health literacy skills in colorectal cancer screening. Cancer Investigation 2001;19: ) Nutbeam D. Health promotion glossary. Health Promotion International 1998;13: ) Weiss BD. Health literacy: an important issue for communicating health information to patients. Chung Hua i Hsueh Tsa Chih-Chinese Medical Journal 2001; 64: ) Schwartzberg JG. Low health literacy: what do your 11) Renkert S, Nutbeam D. Opportunities to improve maternal health literacy through antenatal education: an exploratory 2001;16: study. Health Promotion International 12) Jorm AF. Mental health literacy. Public knowledge and beliefs about mental disorders. British Journal of Psychiatry 2000;177: ) Nutbeam D. Kickbusch I. Advancing health literacy: a global challenge for the 21st century. Health Promotion International 2000;15: ) Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 2000;15: ) Kickbusch I. Health literacy: a search for newcategories. Health Promotion International 2002;17:1-2. 4) Anonymous. Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. JAMA 1999;281: ) Ratzan SC. Health literacy: communication for the public good. Health Promotion International 2001;16: ) Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA 1995;274: ) Baker DW, Williams MV, Parker RM, et al. Development of a brief test to measure functional health literacy. Patient Education and counseling 1999;38: ) Fetter MS. Recognizing and improving health literacy. MEDSURG Nursing 1999;8: ) Parikh NS, Parker RM, Nurss JR, et al. Shame and
8 health literacy: the unspoken connection. Patient Education & Counseling 1996;27: ) Kim SP, Knight C, Tomori C, et al. Health literacy and shared decision making for prostate cancer patients with low socioeconomic status. Cancer Investigation 2001;19: ) Baker DW, Gazmararian JA, Williams MV, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health 2002;92: ) Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of General Internal Medicine 1999;14: ) Gazmararian J, Baker D, Parker R, et al. A multivariate analysis of factors associated with depression: evaluating the role of health literacy as a potential contributor. Archives of Internal Medicine 2000;160: ) Harmon KS. Health literacy. Wasted words. Hospitals & Health Networks 2001;75:30, ) Pirisi A. Low health literacy prevents equal access to care. Lancet 2000;356(9244): ) Yeo SG, Parker G, Mahendran R, et al. Mental health literacy survey of psychiatrically and generally trained nurses employed in a Singapore psychiatric hospital. International Journal of Nursing Practice 2001;7: ) Levin-Zamir D. Peterburg Y. Health literacy in health systems: perspectives on patient self-management in Israel. Health Promotion International 2001; 16: ) St Leger L. Schools, health literacy and public health: possibilities and challenges. Health Promotion International 2001;16: ) Tappe MK. Galer-Unti RA. Health educators' role in promoting health literacy and advocacy for the 21st century. Journal of School Health 2001;71: ) Peterson FL, Cooper RJ, Laird JM. Enhancing teacher health literacy in school health promotion: a vision for the new millennium. Journal of School Health 2001;71:
9 The Concept of Health Literacy and its Application in Health Promotion Satoko Otake*1, Sumie Ikezaki*2 and Yoshihiko Yamazaki*1 The term health literacy has been regarded a relatively new concept. In this paper, we intended to make clear the concept and its implication through a review of overseas papers about health literacy. Health literacy means literacy related to a specific context about health. Health literacy is more developed and specific skill whereas literacy means general social life skill. Early in the 1990s, the definition of health literacy was narrow, and it was regarded as patients' compliance in medical setting. Jakarta Declaration suggested that health literacy fostered effective participation and was critical to empowerment. Also it was suggested that improving health literacy would led changing the social, economical, and environmental determinants of health. It has also been focused that health literacy is increasingly vital to help people critically evaluate health and medical information. In 2000, Nutbeam suggested that improvement of health literacy was an immediate outcome of health education in health promotion. Consequently the role of health education was anew recognized significant. The measure and application of health literacy is developing, and its further study and conceptual development is expected. It is suggestive that the outcome of health education in health and medical care activity is to promote health literacy and that the concept of health literacy poses to change traditional thinking of health professionals. kj.j.h.p.e 2004;12(2):70-78 l Key words: health literacy, health education, health promotion, outcome, and criteria *1 D epartment of Health Sociology, Graduate School of Medicine, The University of Tokyo *2 Department of Health Sociology, Graduate School of Medicine, The University of Tokyo Institute for Health Economics and Policy 78
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* Department of Health Science Health Sociology Section, Juntendo University School of Health and Sports Science, Chiba, Japan (WHO: Ottawa Charter for Health promotion, 1986.) (WHO: Bangkok Charter
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