Reporting Definitions of Health Literacy in Australian Aboriginal and Torres Strait Islander Health Resources: A...

Australian Aboriginal and Torres Strait Islander (Indigenous) peoples experience many inequalities in health status and outcomes compared to non-Indigenous Australians. Given the strong association between health literacy and health status and outcomes, exploring definitions from an Indigenous perspective is critical to understanding what skills and attributes contribute to the development and maintenance of health literacy among Indigenous Australians. This scoping review sought to identify and describe definitions for health literacy found in health and wellbeing studies involving Indigenous Australians and how those definitions informed resource development in these populations.

A scoping review was conducted using Arksey and O'Malley's framework with the modifications recommended by Levac et al. MEDLINE, CINAHL, Emcare, ERIC, Informit and Scopus databases were searched for eligible studies with no restrictions on language or year of publication. The inclusion criteria were that studies required to be full-text peer-reviewed journal articles and empirical studies focused on culturally safe health literacy with Australian Indigenous peoples.

Eighteen studies published between 2012 and 2022 met the inclusion criteria. Three of the studies defined health literacy and acknowledged how it assists Indigenous peoples to access and understand health-related information, aiding in their ability to make informed decisions about their health. In the remaining studies, no explicit definition of health literacy was provided; however, they each described various strategies Indigenous peoples learned to incorporate health information into decisions about health and wellbeing. Three themes within the included studies were identified: underlying health literacy problems, misaligned Western medical practices and difficulties accessing culturally appropriate services.

While many of the studies included in this review reported adaptations of health literacy resources for Indigenous Australians, none of the health literacy definitions reflect the worldview of Indigenous Australians. This review highlights the lack of culturally safe definitions of health literacy informing the development of resources for improving health literacy in Indigenous populations. Definitions of health literacy must include cultural perspectives for future health resource development, including the understanding of health literacy through an Indigenous lens. SO WHAT?: This review provides a summary of definitions of health literacy found in the literature reporting on the development of health resources for Indigenous Australians. These definitions are limited to Western notions of health literacy and therefore may be deemed culturally unsafe for Indigenous Australians. In order to improve health literacy for this population, culturally safe definitions are required to inform resource development. Further co-designed research that privileges the perspectives of Indigenous Australians is warranted to improve health literacy in this population.