Health literacy is a concept that not only focuses on the families' ability to absorb health communication, but also on the social determinants of health (Nutbeam, Harris & Wise 2010). Health literacy focuses on factors that may contribute to inequality in health but also creates understanding of the underlying factors and constituents which can contribute to strengthening and developing the families health literacy.

It is important to make sure that information is understood by all family members. We all as human beings understand information in different ways. Some people might have problems with reading or understanding texts or words and need personalized information and education. It is worthwhile to reflect on some of those issues. WHO define health literacy as the cognitive and social skills which determine the motivation and ability of individuals to gain access to understand and use information in ways which promote and maintain good health. Thus health literacy means more than being able to read pamphlets and successfully make appointments with health care providers. If we support people's access to health information and improve their capacity to use it effectively, health literacy is important to empowerment. Low health literacy may interfere with a person's abilities to effectively interpret health information or to meaningfully engage in mental health interventions which may result in poor self-care management, increased disability and morbidity (Krishan, von Esenwein & Druss 2012). A high level of health literacy can be seen as a right and a matter of justice and is essential to achieving and maintaining physical and mental wellbeing.

  • Discuss who is responsible for ensuring that a family assimilates and uses relevant health information - is it society or the family itself?
  • Thinking about family members, what justice and equality issues do you see in your practice environment when it comes to Health Literacy? How can they be remedied?
  • What possibilities and limitations are there when it comes to supporting and developing a family's health in health promotion?
  • Discuss health literacy as a social determinant of a family's health.

The need for information and knowledge is very high in the family, especially if they are facing mental health problems for the first time. These needs may differ from the needs perceived by mental health professionals (Sung et al., 2004). With psychoeducation, the aim is to provide information to help family members to understand mental health problems and their impact on everyday life of the service user and other the family members. In addition, information about what services are available and how these can be accessed should be provided to family members (Tweedal et al., 2004; Sin et al., 2007).

When working with families, term psychoeducation could be changed to family education. There are studies showing the benefits of family education from different viewpoints (Xia et al 2011; Magliano 2005; Navidian et al 2012; Zhao et al 2015). But there is also still a lot to do in the area of psychoeducation. Different kinds of of psychoeducation can be used, for example family groups might be highly beneficial as they enable also peer-support (Xia et al 2011; Navidian et al 2012). Different materials can also be used, like leaflets or videos and today there are also many websites, web-based programs or mobile applications available.

It is important to consider the age of the family members and other factors like cultural differences, which you might need to take into account in family education (Shin 2004). Family education also includes children and should be seen as a promotive action supporting everyones mental health. To work with children where there is a family member who has mental health problems, there are different programs available.

In our meeting with the Smith family, we would like to briefly describe that family education could be seen as sharing knowledge in the mutual interaction. It is not about giving or getting information, but about sharing the knowledge (Kilkku et al 2003). The Smith family have knowledge on their everyday life and the reality of how Lily's tiredness affects everyone. The practitioner working with them, has knowledge about these kind of situations because of her education and experiences. All these different kinds of knowledge are shared for common good in the meeting.

Look at animation on Health literacy and psychoeducation

  • After watching the animation, think about the needs for family education from each family member's viewpoint.
  • What do you think about the age-groups of boys? Did they receive enough information, were they listened to?
  • What about Lily's viewpoint ?
  • Or her husband's ?
  • If you were the practitioner in the meeting, would you do something differently? use literature to support your arguments and comments.

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Kilkku N, Munnukka T & Lehtinen K. 2003. From information to knowledge: the meaning of information-giving to patients who had experienced first-episode psychosis. Journal of Psychiatric and Mental Health Nursing 10 (1), 57-64.

Krishan S, von Esenwein SA, & Druss BG. (2012). The health literacy of adults with severe mental Illness. Psychiatric Services, 63, 4, 397.

Magliano L, Fiorillo A, Fadden G, Gair F, Economou M, Kallert T, Schellong J, Xavier M, Pereira MG, Gonzales FT, Palma-Crespo A & Maj M. 2005. Effectiveness of a psychoeducational intervention for families of patients with schizophrenia: preliminary results of a study funded by the European Commission. World Psychiatry 4(1), 45–49.

Nutbeam D, Harris E & Wise M. (2010). Theory in a nutshell: A Practical Guide to Health Promotion Theories. North Ryde, NSW:McGraw-Hill, Australia

Navidian A, Kermansaravi F & Rigi SN. 2012. The effectiveness of a group psycho-educational program on family caregiver burden of patients with mental disorders. BMC Research Notes 5, 399.

Sherman, MD. 2003. Rehab Rounds: The Support and Family Education (SAFE) Program: Mental Health Facts for Families. Psychiatric Services 54(1), 35-37.

Shin, S-K. 2004. Effects of Culturally Relevant Psychoeducation for Korean American Families of Persons with Chronic Mental Illness. Research on Social Wor k Practice 14(4), 231-239.

Sin J & Norman I. 2013. Psychoeducational interventions for family members of people with schizophrenia: a mixed-method systematic review. Journal of Clinical Psychiatry 74(12), e1145-62.

Sin, J, Jordan CD, Barley EA, Henderson C, Norman I.2015. Psychoeducation for brothers and/or sisters of with severe mental illness (SMI). Cochrane Database for Systematic Reviews, published 8 May 2015.

Sung S, Hixson A & Yorker BC. 2004. Predischarge psychoeducational needs in Taiwan: comparisons of psychiatric patients, relatives, and professionals. Issues in Mental Health Nursing 25 (6), 579-88.

Xia J, Merinder LB & Belgamwar MR.2011. Psychoeducation added to standard treatment for schizophrenia reduces relaps. Cochrane Database for Systematic Reviews, published 15 June 2011.

Zhao S, Sampson S, Xia J & Jayaram MB. 2015. The effectiveness of brief psychoeducation (10 sessions or less) for people with serious mental illness. Cochrane Database for Systematic Reviews, published 9 April 2015.

The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.