Self-management, a challenge for people with low health literacy that needs tailored action

Poor health literacy is shown to negatively affect people´s capacity to self-manage diseases. Monique Heijmans highlights the importance to improve health literacy and how COMPAR-EU aims to respond to health literacy problems.

31. March 2020 | by Monique Heijmans, PhD | Senior Researcher at Nivel, the Netherlands

People are expected more and more to play an active role in their own health care. For many individuals such role is difficult and they lack the necessary skills to do so. For successful self-management health literacy is crucial.

Every day, people are confronted with situations that involve important decisions about their health, in supermarkets, at work, at home or during health care visits. Only some of these decisions are taken in a face-to-face contact between patients and health care professionals; many more are made when people are on their own and dealing with often unfamiliar or complex information or situations. For example they have to take medicines following the prescriptions on a pill box, choose between the right foods when following a diet, monitor their symptoms or have to decide how to respond  to a severe public health outbreak like currently with COVID-19.

Health Literacy is much more than being able to read and understand. By improving people’s access to health information and their capacity to use it, health literacy is critical to empowerment.

Health literacy and its importance

To be able to take such decisions and take actions that protect and promote their health, people need the skills to find, understand and use health information. We call these skills health literacy. Health literacy broadly 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 which promote and maintain good health” (Nutbeam, D. 1998).

It has been found that nearly half of the adults in European countries have inadequate or problematic health literacy that adversely affects their health (Sørensen K. et al. 2015). Health literacy has been linked to worse individual health management (overeating, drinking too much alcohol, smoking, lack of exercise, ignoring symptoms), is often associated with a lack of understanding of health advice from public health information campaigns or medical professionals. Poor health literacy has also been shown to affect individuals’ ability to correctly follow prescription instructions for medications, and their capacity to self-manage diseases.


Dr Monique Heijmans

Monique Heijmans works as a senior researcher at Nivel – institute for health services research in the Netherlands. She is an expert in the area of (determinants of) self-management and chronic illness and has extensive research experience in research on psychosocial factors and their interaction with health behavior and health.

Health literacy is not just an individual issue

Given the poor health outcomes, it is expected that improving individual levels of literacy in society would produce substantial health benefits. Improving health literacy in patients provides the foundation on which they are enabled to self-manage more successfully and to play an active role in improving their own health. However, health literacy is not just an individual issue. People can  learn and improve their skills but also health care itself can be changed to make it simpler and more accessible for people with low health literacy. Instead of defining health literacy skills as an individual problem, we can better speak of a mismatch between the patient and the care environment (Heijmans, M. et al. 2015). By improving people’s access to health information and their own capacity to use it effectively (Rademakers, J. Heijmans, M. 2018), health literacy will be critical to empowerment.

In COMPAR-EU we will collate and distribute examples of best practice in health literacy intervention development, and provide evidence of what works, in which contexts, and why. Both on an individual level by looking which kind of interventions can empower people with low health literacy and increase their knowledge, confidence and capacity to act. But also on a health care systems level by picturing context factors that make self-management interventions more successful for people who are less health literate.