Improving health literacy: challenges for health professionals

Health Literacy: “Opening Doors to Health and Wellbeing” Health Literacy: “Opening Doors to Health and Wellbeing” Conference. Conference.

Darwin, 9Darwin, 9thth September 2010. September 2010.

Improving Health Literacy – Challenges for Health Professionals

Dr Anne Johnson, Community Engagement Consultant, SA.

3,408 km

1. Clarity of understanding of the meaning of health literacy.

3. Improving health literacy in practice.

Literacy is increasingly viewed as including a variety of skills needed for an adult to function in society:◦ Quantitative literacy◦ Scientific literacy◦ Technological literacy◦ Cultural literacy◦ Media literacy◦ Computer literacy◦ Financial literacy ◦ Health literacy

Kickbusch, Maag 2006

Health literacy is the capacity to make sound health decisions in the context of everyday life

Health Literacy•Functional•Interactive•Critical

Home + communityHealth–care system

Political

Health Related Goal Examples of Tasks and Skills Needed Promote and protect heath and prevent disease

• Read, comprehend, and make decisions based on food and product labels

• Find health information on the internet or in publications

Understand, interpret, and analyse health information

• Analyse risk factors in advertisements for health products • Determine which websites contain accurate information • Understand the implications of health-related policies in order

to vote Apply health information over a variety of life events and situations

• Determine and adopt guidelines for increased physical activity at an older age

• Read and interpret safety precautions at work • Choose a health fund

Navigate the health-care system

• Know which services are available and the cost • Locate the health services and find one’s way in a busy

hospital Actively participate in encounters with health-care professionals and workers

• Ask questions • Make appropriate decisions based on information received • Work in partnership with care providers to manage chronic

disease Understand and give consent

• Comprehend required informed consent documents before procedures or for involvement in research

Understand and advocate for rights

• Request access to information • Advocate on behalf of others such as elderly or mentally ill

Source: Institute of Medicine of the National Academies, 2004, Health Literacy. A prescription to end confusion. Table 2-1 page 42

Critical Health

Literacy

Interactive Health

Literacy

Functional

Health Literacy

Level of Health Literacy Individual Role

Pro-Active

Active

Passive

Functional Literacy

Basic Health Knowledge

Empowerment

Advanced Health Knowledge

Critical Thinking

& Analysis

Social Support and Networks

Kickbusch based

on Nutbeam

Health literacy is a key outcome from health education and communication.

Evolved in sophistication, reach, and relevance to a wider range of population groups based on an understanding of the social determinants of health.

Nutbeam (2000)

Shows that 59 per cent of the Australian population aged 15 to 74 years did not achieve health literacy skill level 3 (out of 5) or above, which is the minimum required for individuals to meet the complex demands of everyday life and work in the emerging knowledge-based economy.

Australian Bureau of Statistics, Health Literacy, Australia, 2006, Catalogue No. 4233.0,

Australian Bureau of Statistics, Canberra, 2006.

Cultural and language differences and socioeconomic status interact with and contribute to low health literacy.

◦ Increase health literacy.◦ Involve patients so that they can make

decisions about their care and plan their lives. ◦ Provide care that is culturally safe.

Goal 3: Creating an agile and self-improving health system. ◦ Strengthening consumer engagement and

voice is recognised as a key lever in this process.◦ Health literacy is recognised as instrumental

in encouraging consumer engagement.

What are the key elements of an enhanced primary health care system? (lists 10 elements)

2. Patient-centred and supportive of health literacy, self-management and individual preference.

Source: Institute of Medicine of the National Academies, 2004, Health Literacy. A prescription to end confusion. Figure 2-2 page 34

“Country Patient Journey Health Literacy Audit Tool - for Country Health Services Making your Health Service Country Patient Friendly”(karen.dixon@health.sa.gov.au)◦ Navigation◦ Written Communication (e.g. health

information resources)◦ Verbal Communication◦ Technology◦ Policies and Procedures

Socioeconomic status, education level, and primary language all affect whether people will seek out health information, where they will look for the information, what type of information they prefer, and how they will interpret that information.

80% of the worlds population live in oral and visual cultures i.e. Cultures that learn through listening and watching, not through reading or writing (Goody, 1968).

Predict that developed societies are moving in this direction as well (Grossman 1999).

The media is increasingly becoming a key source of health information.

New information technologies are providing opportunities that are more visual and interactive than pamphlets and older, more didactic forms of health instruction. Access to these technologies is variable and inequitable.

THE THREE DIVIDES: ◦ HEALTH, EDUCATION, AND DIGITAL

(Kickbusch 2001)

Higher percentages of adults with Below Basic or Basic health literacy than adults with Intermediate health received a lot of information about health issues from radio and TV.

Adults with Proficient health literacy were least likely to receive a lot of information about health issues from those same non-print media sources.

(US Dept of Education Institute of Education Sciences, 2003, National Assessment of Adult Literacy)

Higher percentages of adults with Below Basic or Basic health literacy than adults with Intermediate health received considerable information from friends/family and health professionals.

(US Dept of Education Institute of Education Sciences, 2003 National Assessment of Adult Literacy)

.

Lower percentages of adults with Below Basic health literacy than adults with Basic, Intermediate, or Proficient health literacy reported that they got information about health issues from any written sources.

80% of adults with Below Basic health literacy did not get information about health issues from the Internet. This compared to 58% with Basic health literacy, 33% with Intermediate and 15% with Proficient.

(US Dept of Education Institute of Education Sciences, 2003 National Assessment of Adult Literacy)

Participants reported the most powerful influences on their knowledge and approaches to parenting and child safety in the home was from social networks: ◦ Friends◦ Family◦ Parent groups

Media (particularly television). Internet - www.essentialbaby.com.au. Magazines - Practical Parenting. Safety organisations. Health professionals and health services. Childcare, kindergarten and school.

wwwwwwwww.kidsafesa.com.au

http://www.essentialbaby.com.au/

Target Country

MEDIA RELEASE

The Newest Vital Sign is based on a nutrition label from an ice cream container. Patients are given the label and then asked 6 questions about how they would interpret and act on the information contained on the label. Takes less than 3 minutes.Weiss B.D et. al.(2005) Quick Assessment of Literacy in Primary Care:

The Newest Vital Sign Annals of Family Medicine 3:514-522

http://www.annfammed.org/cgi/content/full/3/6/514

Evidence does not support clinical screening of literacy. Population based studies have identified reliable profiles.

Taking specific actions to enhance all patient/client interactions – ‘universal precautions’

http://www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf

Assume that everyone may have difficulty understanding.

Create an environment where patients of all literacy levels can thrive.

Clear communication practices and removing literacy-related barriers will improve care for all patients regardless of their level of health literacy.

Patients have difficulty understanding health information that is communicated orally during consultations. Retain about 50%.

People with limited literacy are less likely to:◦ Ask questions◦ Seek information from print resources◦ Understand medical terminology and jargon.

Teach-Back method Brown bag medication review

People with limited literacy skills have difficulty understanding written information including:◦ medication dosage instructions and warning labels◦ discharge instructions◦ consent forms (treatment and research)◦ basic information about diseases, nutrition,

prevention and health services.

Health care providers rely heavily on print material to communicate with patients.

The Cochrane Review, “Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home”, found that ◦ the knowledge and satisfaction of patients and/or

significant others appears to improve when a combination of verbal and written health information is provided compared to verbal information only.

(Johnson A, Sandford J, Tyndall J, 2003, Issue 4, The Cochrane Library)

More than 300 studies in the US indicate that health-related materials far exceed the average reading ability of US adults.

Readability Formulas e.g.:◦ Flesch Kincaid formula in Microsoft Word◦ SMOG

Performance-based testing:◦ Consumer testing on 2 rounds of 10

participants 1:1 (15 questions asked to locate information on prepared flier). Prepare a readability report (*Also called consumer evaluation).

Most common flaw is where health professionals ask consumers to comment on the design and content of an existing draft (Coulter et. al. 1999)

Consumers and health professionals work collaboratively to write and design = Consumer/Community engagement.

Understanding is a two way street. Eleanor Roosevelt

This is mine! What do other staff think of this! Let’s do it as a department/team! Let’s form a committee and ask a consumer

to join! What do consumers think should be included? The consumer(s) want to do it and want us to

help!

NHMRC (1999) How to present the evidence for consumers: preparation of consumer publications.http://www.health.gov.au/nhmrc/publications/synopses/cp65syn.htm

Victorian DHS (2000) Well written health information: A guide.http://www.health.vic.gov.au/consumer/downloads/dhs1074.pdf

Better Information and Communication Practices

http://fahcsia.gov.au/sa/disability/pubs/policy/Documents/cds/bicp/default.htm

Communication Rights Australia (CAUS) – communication tool for people with speech and communication difficultieshttp://www.caus.com.au

Communicating Positively. A guide to appropriate Aboriginal terminology

http://www.health.nsw.gov.au/pubs/2004/pdf/aboriginal_terms.pdf

Limited health literacy has been associated with ◦ Poor adherence, self-care behaviours, and

understanding of health information.◦ Poorer control of chronic conditions.◦ Less likely to ask questions or participate in

decision making.

Encourage questions – Ask me 3◦What is my main problem?◦What do I need to do?◦Why is it important for me to do this?

Additional questions for people living in country/rural and remote areas:◦ Can I have the treatment locally?◦ Is video-conferencing an option?◦What assistance can I get to help me travel?◦What accommodation assistance is available?

Some patients, especially those with limited literacy, are not going to achieve their health goals unless you go the extra mile to help them access and obtain services.

Link patients to medical and non-medical supports e.g.◦ Food pantries; Transport support; ◦ Budget management program◦ Support group; Exercise program; Diabetes education◦ Smoking cessation programs◦ Employment assistance program

Patient Pathway Officers/Patient navigator programs

Thank you!

anne@communityengagement.com.au