Health literacy: finding the answers online

1 December 2012

Dr KATHY HOLLOWAY asks what the connection between evidence-based practice and health literacy is.

Evidence-based nursing is the foundation of professional practice – as evident in the Nursing Council of New Zealand competencies for registered nurses. However, evidence-based nursing (EBN) is more than simply finding the latest evidence and acting on that.

The Sigma Theta Tau International society defines EBN more broadly as “an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served”. Some definitions also include the consideration of the fiscal impact or constraints in care delivery.

This level of optimal care and integration assumes that nurses have access to a synthesis of the latest research, a consensus of expert opinion, and are thus able to exercise their judgment as they plan and provide care that takes into account the cultural and personal values and preferences of those receiving care. How are you placed in relation to your practice area? Can you access quickly the synthesised latest research, expert opinion from senior colleagues and integrate this with the values and preferences of your population?

Provide safe, effective patient care by locating the best available evidence online. Website portals such as New Zealand Guidelines group ( and Joanna Briggs Institute ( provide quality assured synthesised evidence of both research and expert opinion to begin the process.

There are three recognised common barriers to implementation of EBN – lack of time, overwhelming amounts of information and lack of knowledge. Implementation science is a growing field of study which considers methods to promote the integration of research findings and evidence into healthcare policy and practice. Check out the Fogarty Institute at National Institute of Health in the USA (

The values and preferences of individuals are additionally influenced by how confident people are with the information provided – i.e. their health literacy. Health literacy has been reported to be one of the strongest demographic factors associated with health outcomes, greater than age, ethnicity, and other socioeconomic factors. One of the key elements in this is communication between the clinician and patient. This ranges from what is being discussed at the point of care, how it is conveyed through to whether it’s understood – essential to cover the remaining elements of the EBN model. <<<Ask Me 3>> [featured site this month] is a patient education programme designed to promote communication between healthcare providers and patients in order to improve health outcomes. The programme encourages patients to understand the answers to three questions:

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this?

Using this framework you can ensure that with awareness you, your patients and communities can make choices in relation to evidence-based nursing practice.

Dr Kathy Holloway is dean of the Faculty of Health at Whitireia Community Polytechnic.


Ask Me 3 – National Patient Safety Foundation

The Partnership for Clear Health Communication (PCHC), USA’s leading non-profit organisation dedicated to improving low health literacy, joined forces in 2007 with the National Patient Safety Foundation (NPSF) to form the Partnership for Clear Health Communication at the National Patient Safety Foundation and launched this website. The website aims to provide resources for patients, individual providers and organisations to support health literacy. These resources are free to download and whilst it is important to remember that guidelines, procedures and appraisals developed with one context in mind do not necessarily translate, there is merit in considering the work others have done. [Site accessed 19 November 2012 and last updated October 2012.]

Implementation Science online journal

This site hosts an open access, peer-reviewed online journal that aims to publish research relevant to the scientific study of methods to promote the uptake of research findings into routine health care in clinical, organisational or policy contexts. As well as hosting papers describing the effectiveness of implementation interventions, Implementation Science provides a unique home for articles describing intervention development, evaluations of the process by which effects are achieved, and the role of theory relevant to implementation research. Recent articles consider the value of clinical networks and implementation of nutrition guidelines in older person’s residential care. [Site accessed 19 November 2012 and last updated 2 November 2012.]