Socioeconomic health inequalities and health literacy

Many citizens are hardly reached and involved in public health services. This leads to preventable socioeconomic health inequalities which I think are unacceptable. One of the underlying factors is health literacy. About 25% of the Dutch citizens experience problems in obtaining, understanding, appraising and applying information to make decisions in for example cancer screening, vaccination and lifestyle. 

In my research program I aim to improve the health literacy responsiveness of public health services. I systematically develop and implement innovative interventions to improve decision support in cancer screening, vaccination and lifestyle changes. Examples are a digital decision aid for colorectal cancer screening invitees, a mobile application to support vulnerable young mothers in lifestyle changes, and a training for professionals in breast cancer genetic counseling. Interventions are systematically developed in co-creation with individuals with varying health literacy levels, professionals, and other stakeholders.

Focal points in my research 

1) Concepts and measures for health literacy and decision-making

Measures are essential for intervention development and evaluation. In the past 12 years I have developed conceptual frameworks and measures to gain insight in how individuals make decisions, for instance on screening, vaccination and lifestyle changes, thereby focusing on the role of health literacy. I was one of the first to validate health literacy measures and significantly contributed to the knowledge base for health literacy research in the Netherlands. 

In my current research I explore underlying interactions between health literacy and other factors also at institutional, community and policy level, that influence individual decision-making in public health. 

2) Digital communication technologies (eHealth)

Digital communication technologies in health care (eHealth) offer opportunities for health literacy responsive decision-making support and communication. However, many of these eHealth interventions have been developed without taking into account needs and preferences of citizens, clients, patients, professionals and other stakeholders. They therefore lack sufficient relevance and hardly meet conditions for implementation in practice. In my research I systematically develop and implement digital interventions in co-creation with individuals with varying health literacy levels, professionals and other stakeholders. I thereby closely collaborate with the eHealth Living and Learning Lab of the department of Medical Informatics.

3) Reach and involve citizens in public health (research)

Increasing research participation of citizens that are not easily reached is challenging. Based on my experience I believe that involvement is key. In all of my projects I involve relevant stakeholders from the start of grant writing to valorization of results. I invest in building trust and maintaining relations.

My dot on the horizon is to reach low health literate individuals with research and support them in decision-making at the same time. After all, barriers to participate in research are largely the same as barriers for individual decision making, for instance in screening and vaccination. In current projects we are going to combine, apply, and evaluate innovative methods to reach and involve hard-to-reach populations in public health services and scientific research.