Health Literacy NZ was set up at the end of 2015, with our team of people coming from Workbase Education Trust (which closed at the end of 2015). Our team's experience has come from creating innovative health literacy products and services for organisations across the health sector while at Workbase. Here are some examples of our work.

Self management support toolkit

As part of the Self management support toolkit we developed with Health Navigator for the Ministry of Health, Susan prepared this video which describes the equity issues in health care and how these might be addressed, using gout as an example.https://www.healthnavigator.or...

Gout is an interesting case because it is widely misunderstood and misrepresented in health care and the community, meaning people do not get effective preventative treatment. For instance, gout is perceived to be a condition caused by diet and therefore self-inflicted, when in fact for Maori and Pacific people (who are disproportionately affected by gout), it is a genetic condition which causes them to store high levels of uric acid no matter what they eat. While more likely to suffer from gout, Maori and Pacific people are less likely to be prescribed medicine which reduces uric acid levels, preventing gout attacks and long-term joint damage. Building an accurate understanding of gout and managing this long-term condition effectively are issues of equity in health care.

NZMJ Digest

Here is a recent article we wrote for the New Zealand Medical Association, describing how health literacy needs to be seen as an ever-changing state created by the health challenges we face and the complexity of the health system, rather than as a patient trait.  The phrase “people with low health literacy” only tells one side of the story, published in the February 2020 edition of the NZMJ Digest

International Handbook of Health Literacy 2019

We were honoured to be asked to contribute a chapter about the history of health literacy in New Zealand to the International Handbook of Health Literacy - Research, Practice and Policy across the Life-Span edited by Orkan Okan, Ullrich Bauer, Diane Levin-Zamir, Paulo Pinheiro and Kristine Sørensen (2019).  Here is our chapter, Health literacy in New Zealand: A tale of serendipity and indigenous health, as well as the link to the handbook.

Award from the Institute for Healthcare Advancement

Susan Reid was one of the joint winners of the inaugural international award for health literacy from the Institute for Healthcare Advancement. The award presented on 4 May 2016, recognises efforts to better health through improved health literacy. Susan's award recognises, among other things, the recent work she and her colleague Carla White completed in developing a Guide for health care organisations to use to review whether they are health literate organisations. Susan has also been involved in a number of health literacy projects at Counties Manukau Health including workforce development with Well Child Tamariki Ora nurses, community midwives and others in the Te Rito Ora project; the Live Kidney Donor project; professional development for primary care nurses as part of ARI training; and the Maaori Gout Action Group.

The Institute for Healthcare Advancement is a not for profit organisation based in California, USA which has led health literacy efforts on the West Coast.

Susan was presented with her award by Dr Rima Rudd form the School of Public Health, Harvard. Dr Rudd visited New Zealand in 2012 to present at the health literacy conference From Discussion to Action and provide guest lectures on health literacy for a number of District Health Boards.

Rheumatic fever prevention and treatment

We have been supporting the Ministry of Health's Rheumatic Fever Prevention Programme.
In 2015 we provided training for Healthy Homes Providers on how to use the Key tips for a warmer, drier home toolkit with families.The workshops were designed to train a trainer in each provider who in turn would train their colleagues to use the toolkit and take a health literacy approach to working with families.

In 2014 we worked on antibiotic adherence as research found that adherence was poor with two thirds of children with strep throat not completing the ten day course of antibiotics prescribed, leading to further infections.

Families told us they knew that sore throats had the potential to cause rheumatic fever and were seeking diagnosis and treatment for children's strep throats as soon as possible. Most families had been told to administer antibiotics for ten days or until finished. However, families had not been told why it was important to finish the ten day course of antibiotics, or how antibiotics work over time to treat bacterial infections like strep throat. This made it more likely that antibiotics might be missed once a child feels well.
As a result, we developed explanations and a poster for health professionals to use to explain how antibiotics work over ten days to treat a strep throat. We also provided professional development for school nurses, public health nurses, community health workers and pharmacists about taking a health literacy approach in discussions with children and families. Once families understood how antibiotics work over time, they were more likely to make sure children finished antibiotics – even when they no longer had symptoms of a sore throat.

The poster is available here and on the Ministry's website at and can be used with parents, caregivers and children. The professional development provided was based on the Three Steps to Better Health Literacy Guide developed originally for community pharmacists.

Health literacy review - a guide

While at Workbase we developed Health Literacy Review - A Guide for the Ministry of Health. The Guide shows large healthcare organisations how to review their services from a health literacy perspective, identify what they are doing well, and develop Health Literacy Action Plans for service improvement. Dr Rima Rudd from the Harvard School of Public Health provided peer review for the Guide.

The Guide describes the characteristics of a health literate organisation and uses a system-wide approach to review health services, taking into account:
  • strategic direction and leadership support
  • service and process design
  • communication mechanisms
  • workforce capability
  • access to support and services,
  • the experiences of consumers and families.
Using this approach enables organisations to identify the changes they can make within and across services to reduce the health literacy demands faced by consumers and families, and how to better work with consumers to build the health literacy skills and knowledge needed to effectively manage their health.This is part of the journey to become a health literate organisation.

To develop the Guide we worked with three District Health Boards to trial and amend the health literacy review process in different contexts. We produced supporting material, such as the videos and observation tools, which accompany the Guide and can be found on the Ministry's website. Each review looked at how services and care were planned, structured and delivered as well as how consumers, whānau and families experienced these services.
More information on the Guide is available at

Kidney donors and recipients

As part of a Counties Manukau Health project to increase the number of live kidney donors, we developed written resources for the health workforce to use with potential donors and recipients when explaining the benefits and risks of live kidney donation as well as the process of donation. Focus groups and one-on-one interviews with donors and recipients as well as potential donors and recipients generated ideas about content and provided feedback on the draft resources. A reference group of health professionals provided advice about the clinical issues arising as the resources were developed. Feedback was also sought feedback from transplant coordinators around New Zealand as well as Kidney Health New Zealand and Kidney Society Auckland. Some of the resources can be accessed at:

Health literacy training for community pharmacists

The purpose of this project was to develop, trial and evaluate a health literacy package for community pharmacies. The project was carried out for New Zealand's Health Quality and Safety Commission.

We developed and delivered a training programme and supporting resources to enable pharmacy staff to build health literacy with consumers as part of everyday interactions, particularly when helping consumers understand their medicines and how to use them safely. Two community pharmacies were selected as trial sites to participate in the project. The approach used was to train a lead pharmacist in each pharmacy who then provided health literacy training and resources to their staff. Following their training, pharmacists and other staff had a few weeks to practice some of the strategies for building health literacy with consumers and then we provided follow-up coaching sessions on-site to help reinforce good practice. The project ran for three months from mid-March until mid-June 2013. Participating pharmacies continue to implement the training and work on health literacy using the project resources. The project resources we developed:
  • Health literacy information booklet
  • Health literacy information leaflet
  • Three steps to health literacy
  • Three steps to health literacy - poster
  • 10 questions about health literacy
  • 10 answers about health literacy
  • 10 more questions about health literacy
  • 10 more answers about health literacy
The resources produced for pharmacists are available under the Resources tab.

The project was evaluated by Malatest International. The evaluation report includes recommendations that all community pharmacists be offered health literacy training to ensure that consumers understand why they are being given medicines, how to take them, and their risks and benefits. The report is available at

Gout prevention and early detection

Gout is the most prevalent form of chronic arthritis in the world and yet it is the most treatable form of arthritis. The rate of gout in Māori is 2.5 times higher than European, with Māori men particularly affected.

We carried out research for the Ministry of Health to:
  • identify how health literacy is a barrier and/or a facilitator in the prevention and early detection of gout
  • highlight any interventions or approaches that may be effective in strengthening health literacy for Māori at risk of developing gout or who are living with the condition
  • demonstrate ways to increase health literacy in order to improve outcomes associated with gout.
The research project found that people with gout, and some primary care health professionals, share the myth that gout is caused by consuming too much protein and alcohol. In fact, Māori and Pacific are at higher genetic risk of hyperuricaemia progressing to gout.

Health organisations and health professionals have a key role in building the health literacy of whānau about the prevention and early detection of gout.

Resources for both patients, whānau and health professionals were created as part of the project and can be found under the Resources tab.

Health literacy and the prevention and management of skin infections

New Zealand has one of the highest rates of childhood skin infections in the Western world. We carried out research for the Ministry of Health to:
  • identify health literacy barriers and facilitators in the prevention and management of skin infections
  • highlight interventions that may be effective in strengthening health literacy for better prevention and management of skin infections
  • demonstrate ways to increase health literacy in order to improve outcomes in skin infections.
The research involved consulting parents, caregivers, health professionals and teachers about what would help prevention and management of skin infections in children. The research led us to create a range of resources for parents and families, talking points (suggested scripts) for health professionals when using the resources with patients and families, and skin health lesson plans for teachers. The resources for parents, health professionals and teachers can be found under the Resources tab or or
All the resources should be printed in colour.

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