I was walking with my friend Lori today and among the many things we chatted about, one of them was health literacy – the topic for my PhD dissertation. I had talked a bit about how health literacy isn’t just a skill but rather it is a practice. I read an article by Uta Papen that talked about health literacy as social practice.
The article mentions a different frame of reference for defining health literacy – specifically:
The study was grounded in a view of health literacy as social practice. Accordingly, we talked about health literacy ‘practices’ rather than health literacy ‘skills’. Setting aside the notion of skills, we were able to explore what people do with reading and writing rather than to ‘assess’ how good (or bad) they are at what they are doing. This is not to say, however, that we were not interested in people’s abilities. But we did not define these as narrow skills. Rather we conceptualised them as context-bound and changing competencies, some of which, as I will show below, were not located in individuals but in groups and social networks. (Papen, 2009, p.21-22).
One thing that came up in our conversation was the importance of self-awareness and body-awareness as a health literacy. Both Lori and I are very aware of our bodies – sometimes this can be rather uncanny. Lori has felt her cancer growing (she has metastatic breast cancer), and has noticed tumors growing before they show up on scans. She is highly aware of when things are not right. This often reminds me of the multiple intelligences theory – and how one of the intelligences surrounds body awareness, but I don’t completely buy it, as I do think that to at least some extent this awareness can be learned.
Our discussion turned towards health literacy, and I found myself asking, is this sense of body awareness or self-awareness a health literacy? Is this something that patients (or people in general) should consider developing – a broader awareness of what is happening within their bodies, but also learning how to express those changes in language that others understand?
And now that gets me thinking about communications issues between patients and doctors (or other healthcare providers). I can recall several times when I have described what I am feeling in a way that has been misinterpretted by healthcare practitioners. Or when I hear them use a term and I think I know what it means, and so I use it to describe what is happening to me, and that description then leads us down a wrong path … so that maybe my awareness was actually a problem.
Hmmm… I’m not sure anymore.
Should people be more aware of what is happening in their bodies? Or is perhaps, willful ignorance also a strategy?
In that very same article, I also wrote myself a note that ‘Passivity could be an intentional expression of self advocacy‘. I’m pretty sure I’ve talked about this idea before. If you are intentionally abdicating decision making, then that can be seen as self-advocacy, as it is in an intentional choice. Abdicating decision making is only a problem when it is not intentional.
What is amusing is that this blog post has meandered from one thought to another, loosely connected and yet somewhat disconnected. This is exactly how my conversations with Lori go … we walk and we talk … we have some good ideas, and not so good ideas … either way, it is a great way to spend an afternoon.