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Irohla FAQ

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What is literacy?

The term literacy is linked to the ability to read and write, but also linked to numeracy and the ability to carry out mathematics. Literacy is also used in a broader sense: being knowledgeable in a particular subject or field.
Therefore we know different types or varieties of literacy. To give some examples:


  • Computer Literacy or digital literacy: the ability to use a computer and its software to accomplish practical tasks. There is special attention for computer literacy and the ageing population in Europe. E-health can make significant impact on health of the ageing population.
  • Cultural Literacy: the ability to understand and appreciate the similarities and differences in the customs, values, and beliefs of one's own culture and the cultures of others.
  • Financial literacy: the ability to understand and take adequate actions in budgeting, monitoring expenditure and accounting for income and expenditure.
  • Information Literacy: the ability to know when there is a need for information, to be able to identify, locate, evaluate, and effectively use that information for the issue or problem at hand.
  • Media Literacy: the ability of an informed, critical understanding of the mass media.
  • Visual Literacy: the ability to understand and produce visual messages.
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What is health literacy?

Health literacy has been defined as the degree to which individuals have the capacity to obtain, process, understand the basic health information and functions of services needed to make appropriate health decisions.

Health literacy in specific can refer to the following:

  • Health literacy is about capacities of people needed to take decisions about their own health.
  • Health literacy is linked to literacy and numeracy, but also encompasses basic knowledge about biology, chemistry, psychology and medicine.
  • Health literacy comprises people’s knowledge, motivation and competences to access, understand, appraise, and apply health information to make judgments and take decisions.
  • Health literacy helps people in everyday life in health care, disease prevention and health promotion to maintain or improve quality of life during the life course
  • Health literacy capacities of older adults can improve by empowering them and giving them more knowledge, skills and self-confidence in making decisions about their own health.
  • Health care workers can contribute by clearer and simpler communication on health issues.

Health literacy knows three sequential levels:

  • Level I, functional literacy, refers to the ability to apply basic skills to health-related materials and is relevant in clinical settings. Persons with poor functional health literacy will be unable to follow directions in written materials and labels. In general these persons have limited abilities to meet their social needs.
  • Level II, interactive literacy, focuses on cognitive skills in a social environment. Negotiating with a service provider or interacting in a support group will require this level.
  • At level III persons are able to evaluate health issues and develop their own private health strategies (called critical health literacy).
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Why focusing on health literacy?

Health literacy is one of the social determinants of health recognised as an important factor in improving population’s health. Health literacy is related to different factors, such as the educational level, socio-economic status, access to health services, and to a variety of cultural, historical and political factors. It is seen as an important issue in the health divide between socio-economic groups. Vulnerable populations include the ageing population, minority groups, migrants, the unemployed, socially isolated people and people with chronic mental and/or physical health conditions.

In order to get more information on health literacy issues in the European Union, the EU financed the European Health Literacy Survey (HLS-EU) in eight countries (Austria, Bulgaria, Germany, Greece, Spain, Ireland, the Netherlands and Poland), which was spearheaded by the Maastricht University. The final report was published in the Summer of 2012.

The European Health Literacy Survey has shown that around 12% of the population in Europe has inadequate health literacy competencies and 35% problematic health literacy competencies.

Low health literacy is consistently associated with increased hospitalisations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medicines appropriately, poorer ability to interpret labels and health messages, and among seniors, poorer overall health status and higher mortality. Inadequate health literacy even independently predicts all-cause mortality and
cardiovascular death among community-dwelling older people

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What is the target group of IROHLA?

IROHLA chooses to focus on older adults. Health literacy in older people is a significant problem. The European Health Literacy Survey showed that health literacy problems increase with age. This is partly due to lower average levels of education in the past, and partly due to losing skills when not challenged in day-to-day life. For the ageing population the “use it or lose it” counts: reading abilities decline to typically three to five grade levels below the last year of school completed.
Moreover, some studies found that up to 5% of healthcare costs are directly related to health literacy problems, with more admissions, lower adherence to prescribed medicines, more complications of treatment and higher utilisation of services. These are issues of particular concern for older people.
Improving health literacy is therefore seen as key priority for enabling good health in Europe amongst senior citizens.

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Does health literacy, and more generally healthy ageing, depends only on me?

Health literacy is a context-dependent competency. It is indeed about you to increase your knowledge to better self-manage your health but it also depends on the way communication about health is done, the way health professionals inform their patients and more generally to what extent the society brings support for patient’s empowerment and self-management.

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What will be the outcomes of IROHLA?

IROHLA’s objective is to look for interventions from the health, social and private sectors aimed at improving the health literacy of vulnerable groups. The main project’s outcome will be a guideline for policy and practice with (max) 20 high potential interventions that together will improve the health of the ageing population.

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What is the expected impact of IROHLA?

The guideline for policy and practice (deliverable of this project) will provide concrete tools for national, regional and local government authorities to start action. The maximum 20 evidence-based interventions for empowerment and health literacy practice can be applied in all European Member States, as they will be selected on evidence and feasibility.
The participation of representatives of the ageing population, academics, local governments, business community and other stakeholders in the project is a guarantee that the feasibility of selected interventions will be high. The extensive network of organisations involved in the project will guarantee that information is indeed available to all stakeholders who bear responsibility for healthy ageing programmes.
Improving health literacy of the ageing population is expected to have an economic impact through reduction of health care costs (better compliance, less readmissions, etc.) and through prolonging active and healthy living.

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How will ICT based solutions be taken into account to improve health literacy?

In IROHLA ICT based solutions will be in particular explored. There are wide opportunities for e-health applications in enhancing health literacy. The project will generate more information on using ICT in services for the ageing population in Europe.  Involved ICT companies can create a European network and offer together applications in various languages.
Other opportunities are technological innovations for e.g. medicine dispensing at home, electronic communication between caretakers and people in need, self-management and peer support through internet, etc. Linking and networking in a comprehensive approach will enhance the mainstreaming of such applications.
Institutions for training and education in health can integrate training in the area of health literacy in their programmes and offer (e-learning) training modules for continuing education.

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Will the project lead to social innovation?

This project will lead to social innovation because it responds to social needs of the ageing population, which are improved self-determination in health related issues. The project will enhance the inclusion of older people with low health literacy competencies in society and healthcare systems. The project will create new social collaborations among stakeholders with new products and services in the health sector. At the same time the project will bring knowledge that can be applied in younger age groups, as this will improve their competencies for health by the time they get older. Synergetic effects of empowerment and health literacy communication will be the fundament of health literacy policy and practices.

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What is the link with the European Innovation Partnership on Active and Healthy Ageing?

The IROHLA project feeds directly into the objectives of the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA). The EIP on AHA aims to increase the average healthy lifespan in the EU by 2 years by 2020. It pursues improvement of the health and quality of life of Europeans with a focus on older people and long-term sustainability and efficiency of health and social care systems. IROHLA makes a clear contribution to these goals. The project will actively seek multi-sector and public-private collaboration, enhancing learning by and from relevant stakeholders. The project adheres to the key principles of the EIP on AHA to produce research results with a wider societal value. Those research results will be practical, actionable and to be replicated and implemented in other settings across the EU.

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How can you be involved in the IROHLA project?

IROHLA invites all government institutions, organisations, NGOs and businesses to submit good practices or initiatives concerning social inclusion and empowerment of older people. IROHLA also encourages you to subscribe to their newsletter (LINK) and social media tools (@irohla, IROHLA LinkedIn Group and Facebook Page “IROHLA FP7 Project on Health Literacy ) to be kept up to date on its upcoming events and results.

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How is IROHLA project funded?

IROHLA receives financial support from the European Union under the FP7 Programme. Twenty partners are participating, such as universities, public health agencies, organisations representing older people, healthy cities, companies and businesses. The coordinator is the University Medical Centre Groningen in the Netherlands. The project will run from December 2012 until November 2015.

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