Challenges and opportunities in building critical health literacy.

Background: Critical health literacy is the least explored domain of health literacy and is addressed by few projects seeking to build health literacy. Lack of research means there is little evidence upon which to design effective interventions. Yet critical health literacy offers potential for individuals and communities to make important contributions to their own and society's health. This paper reports on an evaluation of a community project designed to develop critical health literacy.

Method: The evaluation explored, (a) processes used to build critical health literacy and (b) the impact on the critical health literacy of participants. A mixed methods approach was used combining a pre-and post-intervention assessment of 14 of the 24 participants using the All Aspects of Health Literacy Scale, with participant focus groups and facilitator interviews.

Results: Strategies used to build critical health literacy included informal and participatory learning, supported and independent assessment of the problem, appraising information, familiarisation of health systems and services, and social support. Common to these was learning within the context of participants' lives. Fewer strategies encouraged empowerment and political action. The evaluation showed slight improvements in some critical health literacy competencies: the ability to critically appraise health information and apply it to the context of their own lives and being able to critically question health professionals based on an individual's own research. However, there was no change in participants' ability to understand the determinants of health or involvement in activities for social and political change.

Conclusion: Informal, participatory community projects can successfully build many characteristics of critical health literacy. However, the political action element of critical health literacy remains the least well understood and faces particular challenges in its implementation.