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American Desert

critical health literacy

What is Critical Health Literacy?

Native women make choices about their health every day, such as what they eat or how they

exercise. In order to stay healthy, they must know how to read the labels on food

and medicine, describe symptoms, or use a map to locate the closest health center.  Health literacy is central to women’s ability to access the healthcare systems, communicate with health professionals, and be involved in self-care and in the management of their pregnancies. The ability to read, understand, and act on health information is called health literacy.  There is a strong connection between health literacy and achieving good short and long-health and well-being.


Critical Health Literacy (NASEM, 2021) is more of an empowered approach and takes health literacy a step further. Critical Health Literacy is when you have reached an understanding of health literacy but now wish to learn more by learning about the updated research on treatments, procedures and their outcomes, have more effective conversations with your service providers to make sound decisions about your health and possibly, work with Native and/or non-Native researchers to improve health outcomes by reducing health and healthcare inequalities within your community. 


Linn Gould, a Clinical Instructor in Health Systems and Population Health from Just Health Action ( states says that health empowerment cannot be fully achieved unless critical health literacy is developed and action is taken on the social determinants of health (SDOH are the conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life risks and outcomes). Being empowered in your health is part of the process and the outcome. Ms. Gould worked with the Duwamish to examine the SDOH and its root causes through storytelling within the community. She led the Community-based Participatory Model (CBPF) so that Tribal members maintain ownership of the data, the research findings and outcomes and are able to bring this information back to the community. Critical health literacy can also be used to build resiliency or the power to overcome difficult challenges. It is important that both researchers and Tribal members jointly work toward actions that empower and build Tribal communities and that challenge health inequities especially, Native maternal and women’s health inequalities. Gould focuses on 3 components of the framework to encourage community members to build skills, capacity and act as change agents within the Community-Academic partnerships as follows in the diagram.

Functional Literacy

Gabriel Maldonado is the CEO and Founder of TruEvolution, a community-based organization that advocates for health equity and racial justice to advance the quality of life and human dignity of LGBTQ+ people. He has focused much of his work on stigma (Stigma is a mark of disgrace which may be associated with a person’s mental state; difference in physical state or attached to particular race, ethnicity, religion, gender, age, etc.). Maldonado offered Eight suggestions to implement health literacy in health agencies and institutions.


The U.S. Department of Health and Human Services (HHS) has also adopted two definitions that together comprises health literacy:


  • Personal Health Literacy is the ability of women to find, understand, and use information and services to support their health-related decisions and actions for themselves and others. The brochure Ask Me 3 empowers Native women to improve health and well-being by taking charge of their health and healthcare through improved communications with their families and health care professionals.  The brochure can be retrieved from, you will need to create a free account to access the brochures (Spanish version too).


  • Organizational Health Literacy is the degree to which clinicians and organizations equitably support Native women to find, understand, and use information and services to help them make important health-related decisions and actions for themselves and others. The Shared Approach is an evidenced-based toolkit that helps to improve the relationship between the woman and her provider by opening the lines of communication. 


Working together to stop maternal health inequality in women of color has grown into a global movement. We all have a responsibility to become health literate for ourselves and community and to take the lead in the path of health improvement, even if it is challenging.  Yes, it is necessary for ourselves but it is extremely important to ensure a healthy life course for our future generations - for they are the vulnerable ones at higher risk to the cumulative effects of both time and history, especially if left unchanged. 


Maldonado Eight Suggestions

Ask Me 3 Brochure (English)

Shared Approach / Partnering to Improve Safety, Quality, and the Patient Experience

Shared Approach / Be Prepared to Be Engaged Scripts

Shared Approach / Essential Steps of Shared Decision Making

Shared Approach / Be Prepared (Patient Note Sheet Final 508)

Ask Me 3 Brochure (Spanish)

Shared Approach / Teach Back-Tips (Job Aid Final 508)

Shared Approach / Giving Patients Access to Medical Notes

Shared Approach / Partnering 1

Shared Approach / Be Prepared (Quick Start Final 508)

Shared Approach / Be Prepared (Patient Flyer Final 508)

JAMA Health Forum: Indigenous Maternal Health - A Crisis Demanding Attention

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