The Expert:

Dr Siniva Sinclair

Dr Siniva Sinclair is a public health physician with the Population Health team of Counties Manukau Health, and serves as the clinical lead for the health literacy work across the organisation. She has seen the effects of both poor and good health literacy on the part of health care services, and is passionate about helping services progress in their ability to provide health literate, culturally competent care – with appropriate language access – to everyone who needs it.

Their View:

George was admitted to hospital 28 times in one year. The following year, he was admitted only twice. What made the difference?

Better health literacy is likely to be part of the answer. What may surprise some, however, is that the health literacy of the health system itself is probably the most important part of this.

Health literacy is defined as “the capacity to obtain, process and understand basic health information and services to make informed and appropriate health decisions.”[1]

This definition sounds like an individual skill set. However, it is important to note that in most health settings, there is a significant mismatch between consumers’ health literacy skills and the demands of the health sector. There are two ways to reduce the mismatch:
1. Develop the health literacy skills of consumers.
2. Reduce the health literacy demands of the health sector.

The traditional understanding of health literacy focused on the need to develop the skills of consumers. However, growing awareness of the need to consider both parts of the equation has led to the concept of ‘health literate organisations’.

Health literate organisations “make it easier for people to navigate, understand and use information and services to take care of their health.”[2] For example, health literate organisations:
• make health literacy everyone’s business – leaders, managers, clinical and non-clincal staff
• design systems, processes and services that allow consumers to access services easily
• support operational staff to use health literacy approaches and strategies
• eliminate confusing communication that could prevent consumers from accessing treatments easily
• actively build health literacy of consumers to help them manage their health
• make sure operational staff understand that stress and anxiety affect a consumer’s ability to understand and remember new information.

Cultural competence and language access are key considerations for health literate organisations.

Cultural competence is the ability to function effectively in cross-cultural situations. It is important to realise that culture is not only about ethnicity; we also have organisational and professional cultures that shape our perceptions, beliefs, behaviours and the way we communicate. Being aware of our own assumptions, values and biases, as well as those of others, is a critical step towards becoming culturally competent.

Language access is achieved when people with low English proficiency can communicate effectively with healthcare staff and access healthcare services. In a diverse community like Counties Manukau, where half the Asian population aged over 65 years and a third of the Pacific population aged over 65 years are unable to hold an everyday conversation in English, language access is particularly important.

Translation services and multilingual health education resources are part of the answer to providing language access, but interaction with the healthcare professional remains the primary resource.

How, then, can healthcare organisations provide health literate care for everybody?

One approach to health literacy is to apply a three-step process which assumes that most consumers will have some level of difficulty with health systems at some point in their care, and asks health professionals to communicate accordingly.
1. Find out what people already know about the health condition in question so that health information can be pitched appropriately.
2. Build health literacy skills and knowledge by giving information in logical steps and manageable chunks; explaining technical words; using visuals and/or written materials; reviewing medicines with patients; linking back to and reinforcing what people already know; and emphasising key points.
3. Ensure you were clear by checking the patient understands. If misunderstandings emerge, return to Step 2.[3]

This simple approach enables informed consent and builds understanding and engagement with healthcare. For patients like George, it can make the difference between being sick in hospital and being healthy at home.

1. Ministry of Health. Kōrero Mārama: Health Literacy and Māori: Results from the 2006 Adult Literacy and Life Skills Survey. Wellington: Ministry of Health; 2010. Available at: 
2. Brach C. et al. Ten Attributes of Health Literate Health Care Organizations. Institute of Medicine; 2012. Available at: 
3. Sinclair S. Becoming a health literate organisation [Blog post]. Auckland, NZ: Counties Manukau Health; 21 May 2014. Available at:

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