Health information literacy is not a universal cure to the information inequality or the digital divide but it has the ability to save millions of lives and greatly assist in many different aspects of global development. In India, thousands of women have undergone unnecessary hysterectomies due to patient disempowerment and health information ignorance (McGivering, 2013). In Indonesia, people continue to use mercury in small-scale gold mining because of a lack of awareness of the medical risks of this heavy metal, resulting in whole villages slowly being poisoned (Pressly, 2013). These tragedies are due to a lack of access to health information and educational opportunities resulting in populations being “information poor”, unable to gain easy access to information resources and powerless to determine their own wellbeing (Ogunsola, 2009, pp. 60, 70). In the developing world, there are countless cases of unnecessary death, preventable illness, and medical malpractice that would not have occurred if patients were health information literate. The development of health information literacy programs in developing countries is necessary to assist in bridging the gap between global information and health inequalities.
Health information literacy is an amalgamation of the basic concepts and defining measures of information and health literacy. The rudimentary level health information literacy is the “ability to read, understand, and act on health information”; however this does not provide an adequate description (Ogunsola, 2009, p. 63). As defined by the Medical Librarians Association, health information literacy is “the set of abilities needed to: recognize a health information need, identify likely information sources and use them to retrieve relevant information, assess the quality of the information and its applicability to a specific situation; analyze, understand, and use the information to make health decisions” (Niedzwiedzka, 2013, p. 101). To be health information literate, a person must be free to seek, understand, analyze, and synthesize health information tailored to their individual information seeking desires without intermediaries (Niedzwiedzka, 2013, p. 101). E-health literacy is slightly different than health information literacy because it deals solely with electronic resources and relies heavily on the internet. However, within the context of global health information development, it is far more prudent to look to traditional health information literacy because of limitations on ICT technologies and broadband capabilities within developing nations, referred to as the digital divide. Being health information literate allows people to care for themselves and family members, and make informed decisions when giving consent for medical treatment. This results in a sense of empowerment and self-sufficiency.
Similar to the international development strategies to alleviate information poverty, to bridge the digital divide and to provide universal access to information, scholars and development agencies have begun to look at health information poverty. This type of information poverty stems from three global divides: healthcare, education, and digital (Kickbusch, 2001, p. 290). This leads to international developments in healthcare and health information literacy strategies needing to take an interdisciplinary approach to combat global inequalities. This is especially true for health information literacy because it first requires the existence of healthcare, a working level literacy, the ability access to basic information networks and ultimately the capability to gain meaningful knowledge of health related information. This multi-faceted nature of health informational literacy is apparent in its role in as to key achieving many of the United Nations Millennium Development Goals (UNMDG). These goals include eradicating extreme poverty, improving maternal health, reducing child mortality, promoting gender equality, combatting HIV/AIDS and malaria (Ogunsola, 2009, p. 64). The prevention of communicable diseases, increased immunization and alleviating extreme rural information poverty are key elements in the promotion of health information literacy. Moreover, there is a direct and positive relationship between increased education and literacy rates and the health and wellness of populations within developing countries, specifically women and children, which further facilitates the fulfillment of UNMDGs (Kickbusch, 2001, pp. 290-291).
In the context of development theories, it is necessary to adopt a modernization approach to promote health information literacy. This is because most of the medical and health related information is coming from developed countries. However, health information literacy within this context may exclude indigenous knowledge or traditional medicine of the culture, which is not acceptable. Therefore, a bottom-up approach to health information literacy through grassroots or participatory development could assist agencies and development workers in understanding and adapting to the socio-cultural frameworks in which developing information societies exist. Any attempt at implementing a dependency theoretical framework would result in greater information poverty and possible loss of life.
There are many challenges faced in the development of a health information literate society. The distinction between an industrial or knowledge based economy is a determining factor in the success of health information strategies (Catts & Lau, 2008, p. 15). Tradtionally, knowledge based economies are better for health information literacy, because of national values being placed on information, development, and culture. However, within the developing world many economies are emerging as industrial economies with high rates of Illiteracy and a poor information culture (Ghosh, 2007, p. 143). There is an identifiable lack of awareness on the importance of health within developing countries (Abdullah, 2007, p. 349). Moreover, many developing countries are faced with political constraints, such as censorship. The population is faced with issues of information access as well as information literacy. However, this is less applicable to health information literacy because of the more neutral nature of the information, not normally targeted by filtering or totalitarian regimes (Catts & Lau, 2008, p. 24). It is necessary to understand these types of social and economic determinants to understand the state of information poverty and health information literacy within developing countries and marginalized groups. Cultural beliefs, values, norms, and religion must be taken into account when evaluating and attempting to overcome low information health literacy (Chatman, 1999).
The information seeking behaviour of individuals in relation to health information in developing countries commonly has a negative effect on their information literacy. This is because it is primarily guided towards religious texts, spiritual practitioners, or shamans, and would only seek professional medicinal advice as a last resort (Abdullah, 2007, p. 347). People within developing countries predominantly have health information seeking self-directed by a desire for information about illness that is presently afflicting them. They seek information about traditional, modern and preventative medicine and are less concerned with first aid, exercise and nutrition (Abdullah, 2007, p. 347). Primarily people go first to friends and relatives within their information networks, which is in line with Chatman’s views on information seeking within information impoverished societies (Lingel, 2012, pp. 12, 16). Moreover, information seeking behaviour in reference to health is deeply shaped by the fact that the majority of the global population live in oral and visual cultures that do not learn through reading and writing but rather listening and watching (Kickbusch, 2001, p. 295). This also commonly leads to the dissemination of health information orally and based on indigenous knowledge in traditional medicine (Abdullah, 2007, p. 349). These cultural norms and innate information practices should be a key point of consideration in the study of health information literacy across all demographics in developing regions.
There is an engendered element to health information literacy that is clearly defined within the social and cultural ideologies of many developing countries. There is an identifiable failure of health education for women particularly concerning sexuality and reproduction because of persistent dogmatic religious and cultural beliefs. This is one of the elements, along with illness, stress, and fear, that are limiting health information seeking behaviour in women and therefore not facilitating health information literacy (Burnham & Peterson, 2005, p. 423). Female information seeking behaviour is less effective in the context of female health because of social taboos or religious constraints regarding sexual or reproductive health and a lack of female empowerment in information seeking. Strategies focused on women’s development can help to counteract this common occurrence in developing countries by increasing health information literacy, allowing for the removal of information gatekeepers, and providing an element of privacy in women healthcare information, which can be strong assisted by technology.
ICT-driven health literacy and e-health literacy educational campaigns on television, radio, and the internet provide only a small segment of the population in the developing world with health information. Nevertheless, ICT health information seeking is superior because it allows for individual privacy, medical second opinions, and allows for people to contact resources independently if the needed digital skills and literacy are already established. Moreover, non-digital health information and books are still very important and common resources for health information seeking behaviour and are presently still essential to health information literacy in developing countries (Gavgani, Qeisari, Jafarabadi, 2013, p. 25).
The greatest diffusion of an ICT in the developing world is the mobile phone. Mobile games have been used to raise awareness of health related information on cell phones, an ICT platform that has already been widen adopted throughout the developing world and across socio-economic demographics (Ghosh, 2007, pp. 139-140). An example of this is Freedom HIV/AIDS established in India, offering games such as HIV Cricket and a board game called “Malamaal” for 12 to 18 year olds (Freedom HIV/AIDS, 2013). Moreover, mobile phones in rural Indonesia, account for a particularly successful ICT information strategy for spanning geographical distances and are general affordable (Chib, Lwin, & Jung, 2009, p. 216). This World Vision project connecting midwives and pregnant women was successful because of its ease-of-use as a healthcare communication technology while providing access to previously established healthcare networks (Chib, Lwin, & Jung, 2009, pp. 218, 220). Many different orgainzations have similar health information literacy programs throughout the developing world.
Funding for health information literacy initiatives come from a variety of international and national organizations: non-profits, professional organizations, research institutions, and governments. Organizations dedicated to head global health information literacy initiatives include the WHO, UNESCO, Pfizer, American Medical Associations, Robert Wood Johnson Foundation (Allen, Matthew, & Boland, 2004, pp. 325-326) and the Medical Librarians Association: Librarians Without Borders (Librarians Without Borders®, 2013). However, there is an identifiable need for increased cooperation between UNESCO and the WHO (Nutbeam, 2000, p. 267).
International development targets must aim for adequate global healthcare and later strive to create a health information literate society. Within the context of developing countries, it is first necessary to address basic adult literacy and general health literacy, and through the incorporation of principles of information literacy a person can subsequently become health information literate (Burnham & Peterson, 2005, p. 432). This is essential because health information literacy is the bridge between health promotion actions such as education, social mobilization, and advocacy, and measurable positive health outcomes in a society (Nutbeam, 2000, pp. 262-263). Health information literacy initiatives must be based on a long-term commitment from strong international, national, and local partnerships between healthcare institutions, information professionals, ICT development organizations, and the public. It is possible to overcome the many barriers to health information literacy, empower all global citizens in healthcare choices, and create a happier and healthier international society through information development.