1 Health Literacy: a Panacea or Killer? A relatively new concept! Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) Health Literacy: The Innovative Panacea

1

Health Literac

y: a Panace

a or Killer?

A relatively

new concept!

Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

Health LiteracyHealth Literacy: : The Innovative Panacea The Innovative Panacea for Pasifikans’ Healthfor Pasifikans’ Health

Nursing With No INursing With No Innovation:nnovation: Is Routine Care Without PassionIs Routine Care Without Passion

‘Eseta Fifita-Finau, ONZMCommunity Liaison Officer

Pasifika Medical Association ([email protected])([email protected])

Sitaleki ‘A Finau, MNZM CEO Masilamea Press &

Manager Division of Research, Information and Innovation, Tongan Community Development

([email protected] )([email protected] )

Finau, E & S.A. SPNF Conf. Melbourne (Nov. Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)2012)

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Contents of this session:

Introduction Introduction Define literacy and health literacyDefine literacy and health literacy Importance of Health literacy Discuss the uses of health Discuss the uses of health

LiteracyLiteracy Measurement of health literacyMeasurement of health literacy Health literacy and Immunization Health literacy and Immunization Useful resources for Health literacyUseful resources for Health literacy ConclusionConclusion

We are many NOTNOT one!

Pasifikans are :

Multi-cultural Multi-ethnic

Multi-religiousMulti-linguistic

Life is ‘unity in Life is ‘unity in diversity’diversity’

Multi-ply

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What is ?What is ?

UNESCO defines literacy: as the "ability to: as the "ability to: identify, understand,

interpret, create, communicate, compute,

and use printed and written materials associated with varying contexts, e.g. health

For Pasifikans, literacy, and thus For Pasifikans, literacy, and thus hhealth literacyealth literacy is : is :

multi-plymulti-ply, etc., not not homogenous!homogenous!

What is Literacy ?

Literacy involves a continuum of Literacy involves a continuum of learning, enabling individuals to: learning, enabling individuals to: achieve their goals; achieve their goals; Develop their knowledge, & Develop their knowledge, & potential; and potential; and Participate fully in their Participate fully in their

community & wider community & wider societysociety..

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What is Health Literacy ?

‘‘Health literacyHealth literacy iis the degree to which s the degree to which individuals have the capacity to: individuals have the capacity to: obtain, process, & understandobtain, process, & understand basic health information & services;basic health information & services;

in order to in order to make appropriate health make appropriate health decisions’decisions’

Health LiteracyHealth Literacy is one of the many is one of the many functional literacies functional literacies necessary to necessary to navigate complex systems and new navigate complex systems and new environments/societies.environments/societies.

HH

There are Many Functional LiteraciesFunctional Literacies

Visual Literacy

Computer LiteracyComputer Literacy

Cultural Literacy

Media Literacy

Scientific LiteracyScientific Literacy Spatial Literacy

Information LiteracyMathematical Literacy Mathematical Literacy Historical LiteracyHistorical Literacy

Importance of Health Literacy Health literacy comes from a convergence of Health literacy comes from a convergence of

education, cultural & social factors, and health education, cultural & social factors, and health services.services.

Health literacy is fundamental to Health literacy is fundamental to

the objectives of health promotionthe objectives of health promotion There is no health promotion and thus no health There is no health promotion and thus no health

without health literacywithout health literacy

Poor health literacy create health disparities Poor health literacy create health disparities and the and the NZ Inverse Care Law

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Examples of theUses of Health Literacy

You are using health literacy skills when you:You are using health literacy skills when you:follow instructions on how to take a medication;read a brochure to determine your medical read a brochure to determine your medical benefits;benefits;use information on food or product labels to calculate nutritional content;see a notice & determine whether to screen see a notice & determine whether to screen or immunize;or immunize;fill out a benefit application or patient history formread an article about nutritionread an article about nutritionread a letter on medical test resultsread a letter on medical test results

Health Literacy & education Health literacy Health literacy is not only about education. While reading, writing, & math skills make up part of the basis of health literacy, many other skills & abilities are also important:, such as:Speaking, listening, Speaking, listening, Having adequate background information, &

ability and couragecourage to advocate for oneself in the health system.

Educators and researchers must add Educators and researchers must add health literacyhealth literacy into educational & research plansinto educational & research plans

Ref: Report Brief: Health Literacy: A Prescription to End Ref: Report Brief: Health Literacy: A Prescription to End Confusion (2010)Confusion (2010)

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Measuring Health LiteracyHealth literacyHealth literacy:: measuresmeasures how well you can how well you can understand & understand &

useuse health information. Materials included in this measure health information. Materials included in this measure

are judged to be related to one of 5 activities associated are judged to be related to one of 5 activities associated

with where & why people take health actions. with where & why people take health actions.

These 5 activities involveThese 5 activities involve: : health promotionhealth promotion; health ; health

protection; disease prevention; health care & maintenance; & protection; disease prevention; health care & maintenance; &

accessing services or accessing services or navigating the health system.navigating the health system.

Transmission of information = Transmission of information = {Health promotion}{Health promotion}

is inadequateis inadequate

Health literacy enhance informed actionHealth literacy enhance informed action

Ways to Measure Health LiteracyWays to Measure Health Literacy

Functional measurements: Functional measurements: ALLSALLS – Adult Literacy and Life Skills Survey – Adult Literacy and Life Skills Survey

TOFHLATOFHLA – Test of Functional Health Literacy in Adults – Test of Functional Health Literacy in Adults

Tests reading, comprehension, and numeracy in EnglishTests reading, comprehension, and numeracy in English

Broadly corresponds with education (in English language)Broadly corresponds with education (in English language)

Holistic assessment which includes:

Cultural understandingsCultural understandings, , Attitudes to wellness,Attitudes to wellness,

Expectations of healthExpectations of health, & , & recognises different kinds of recognises different kinds of health literacieshealth literacies

Pasifikans and Health Literacyin NZ

In NZ, majority of Pasifika adults have low In NZ, majority of Pasifika adults have low level one or two LLN skills – of a possible 5 level one or two LLN skills – of a possible 5 levels (Lawes, 2009)levels (Lawes, 2009)

1.62 million (50%) adult New Zealanders have 1.62 million (50%) adult New Zealanders have poor ‘health literacy’ skills (Ministry of Health, poor ‘health literacy’ skills (Ministry of Health, 2010)2010)

Compared to the total NZ population, Pasifikans Compared to the total NZ population, Pasifikans have poorer health outcomes over a wide variety of have poorer health outcomes over a wide variety of measures measures

ReferencesReferences: Lawes, E. (2009). Literacy and life skills for Pasifika adults: Results from the Adult Literacy and Life Skills (ALL) Survey. www.educationcounts.govt.nz/publications/assessment/54836/1

Ministry of Health. (2010). Korero Mārama: Health literacy and Maori. Ministry of Health: Wellington, NZ.

The Need for Health Literacyin the Pacific:

According to a recent Micronesian survey, 80% want more information on health: 22% said that health information was ‘very’ or ‘sort’ of hard to understand.

Other studies found patients with high blood pressure, diabetes, asthma, & HIV/AIDS; have limited health literacy (have poor knowledge of their illness & management)

AnotherAnother study found those with low health study found those with low health literacy skills, report: literacy skills, report: a sense of shame about a sense of shame about their skill level.their skill level.


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PATIENT FACTORS PATIENT FACTORS Navigation Skills Navigation Skills

Self-Efficacy Self-Efficacy

Perceived BarriersPerceived Barriers

SYSTEMS FACTORS SYSTEMS FACTORS Complexity Complexity

Acute Care Acute Care Orientation Orientation

Tiered Delivery Model Tiered Delivery Model

Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)16

1. ACCESS AND UTLIZATION OF HEALTH CARE 1. ACCESS AND UTLIZATION OF HEALTH CARE

PROVIDER FACTORS

Communication Communication Skills Skills

Teaching Ability Teaching Ability

Time Time

Patient-Centered Patient-Centered Care Care

PATIENT FACTORSPATIENT FACTORS Knowledge Knowledge

BeliefsBeliefs

Participation in Participation in Decision Making Decision Making

2.PROVIDER-PATIENT INTERACTION 2.PROVIDER-PATIENT INTERACTION

EXTRINSIC EXTRINSIC FACTORS FACTORS

Support Technologies

Mass Media

Health Education

Resources

PATIENT FACTORSPATIENT FACTORS Motivation Motivation

Problem Solving Problem Solving

Self-Efficacy Self-Efficacy

Knowledge Skills Knowledge Skills

3. SELF-CARE

Health Health OutcoOutcome me

Health Health Status Status

•VisionVision•HearingHearing•Verbal Verbal AbilityAbility•MemoryMemory•Reasoning Reasoning

•OccupatioOccupationn•EmploymeEmployment nt •IncomeIncome•Social Social Support Support •Culture Culture •LanguageLanguage

Race/Ethnicity

Education

Age

Why look at Health Literacy?

Health literacy is the basis of health promotionHealth literacy is the basis of health promotion There is no health without health literacy; There is no health without health literacy;

Lack of access to needed: hardware, software & Lack of access to needed: hardware, software & human ware;human ware;

Without health literacy: Poor Health Outcomes: high non-Poor Health Outcomes: high non-compliance; compliance; Low use and acceptability of Services & Low use and acceptability of Services &

patient dissatisfaction, leading to decreased compliance, and patient dissatisfaction, leading to decreased compliance, and poorer health; poorer health;

Disparities: inequity, inequality, Disparities: inequity, inequality, & discrimination& discrimination

NZ Inverse Care Law persistence NZ Inverse Care Law persistence

Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

Practical Outcomes of Health Literacy:

Healthful diet lead to better academic Healthful diet lead to better academic performance in children. (Better)performance in children. (Better)

School health programs improve academic School health programs improve academic outcomes for children. (Davis)outcomes for children. (Davis)

Promoting students' health lead to Promoting students' health lead to higher academic scores & higher rates higher academic scores & higher rates of high school completion (Vinciullo)of high school completion (Vinciullo)

Health literacy help students maintain Health literacy help students maintain & improve their health, prevent & improve their health, prevent disease, & reduce health risk disease, & reduce health risk behaviors. (Kann)behaviors. (Kann)

18Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

Health Literacy &Health Care Services

Improves navigation of Systems; Improves navigation of Systems; Improve use health service, e.g., better Improve use health service, e.g., better compliance;compliance;Improve self-care and choices of care;Improve self-care and choices of care;Improve helping others; Improve helping others; Improve health prevention & Improve health prevention & protection;protection;Improve systems management;Improve systems management;Reduce health risk behaviors; and Reduce health risk behaviors; and Primary healthcare without health Primary healthcare without health literacy is a dangerous jokeliteracy is a dangerous joke


Health literacy and preschool health programs.

Assessments of early interventions show short term benefits for the child: enhanced achievement, improved health, increased non-cognitive skills, & social competence.

In the medium term medium term society benefits society benefits from: greater school system efficiency; reduction in special education; reduction of grade repetition; higher learning; reduction in abuse & neglect; & lower reliance on health care.

In the long term, long term, children benefit children benefit from: higher higher likelihood of graduation and college enrollment; higher likelihood of graduation and college enrollment; higher wages & employment; lower teen pregnancy; less wages & employment; lower teen pregnancy; less delinquency.delinquency.

Society benefits Society benefits from: sound education; increased tax from: sound education; increased tax revenues; lower welfare dependence; and reduction in revenues; lower welfare dependence; and reduction in delinquency & crime. (Patrinos)delinquency & crime. (Patrinos)

How to Build Health Literacy?How to Build Health Literacy?Nurses can help improve patients’ health Nurses can help improve patients’ health literacy by:literacy by:taking time to understand the health literacy taking time to understand the health literacy demands faced by their patients;demands faced by their patients;building patients’ health literacy; knowledge building patients’ health literacy; knowledge and skills over time; and skills over time; ensuring patients understand the information ensuring patients understand the information or instructions they have been given or instructions they have been given (simply (simply asking “do you understand?” is not enoughasking “do you understand?” is not enough););participating in health literacy professional participating in health literacy professional development; and development; and encouraging their organisation to develop and encouraging their organisation to develop and implement a health literacy action plan.implement a health literacy action plan.


“Improving Health Literacy

To get the best health outcomes, health decisions must To get the best health outcomes, health decisions must be based on clear & correct understanding of relevant be based on clear & correct understanding of relevant health information & services; health information & services;

People with cultures different from mainstream society People with cultures different from mainstream society may have attitudes, customs, languages at odds with may have attitudes, customs, languages at odds with normal health practices;normal health practices;

There are many challenges to educate, prepare, & There are many challenges to educate, prepare, & assist people in obtaining the resources they need to assist people in obtaining the resources they need to make good health decisions;make good health decisions;

Clear communication, in ethnic languages, about health Clear communication, in ethnic languages, about health information & services help create & promote health information & services help create & promote health literacy; and literacy; and

Value traditional medicine & local wisdom.Value traditional medicine & local wisdom.Ref: http://www.plainlanguage.gov/populartopics/Health literacy/

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Pasifkans’ preferences for Health Materials

Pictures of real people, children and parents

Information provided within the Information provided within the context of a trusted relationshipcontext of a trusted relationship

Information needed to come across in conversations and also be in written form so points could be clarified

Information needed in different Information needed in different languages. Wanted resources that languages. Wanted resources that were ‘age appropriate’ and ‘not middle were ‘age appropriate’ and ‘not middle class’.class’.

Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 23

Conclusion & Summary

Ethnic specific Health literacy services Ethnic specific Health literacy services Essential;Essential;

Health Literacy is protective from diseases Health Literacy is protective from diseases and social ills;and social ills;

Health Literacy will solve the Health Literacy will solve the Inverse Care Inverse Care Law and Disparities;Law and Disparities;

There is no Health without Health Literacy;There is no Health without Health Literacy;

Health Literacy essential for improved Health Literacy essential for improved health access, utilization, & outcomes; and health access, utilization, & outcomes; and

Health Literacy must be part of any health Health Literacy must be part of any health serviceservice


Health Literacy: A Prescription to End Confusion (2004)

Free:Free:http://www.nap.edu/openbook.php?isbn=0309091179


Health Literacy Health Literacy is the most is the most common cause of common cause of death among death among Pasifikans in NZPasifikans in NZ

For Health Consumers: ‘10 Top’‘10 Top’ Useful Websites

particularly useful websites in alphabetical: particularly useful websites in alphabetical: Cancer.gov Centers for Disease Control and Prevention (CDC)

www.cdc.gov familydoctor.org health finder® www.healthfinder.gov HIV InSite http://hivinsite.ucsf.edu/ Kidshealth® http://kidshealth.org/ Mayo Clinic http://www.mayoclinic.com/ MedlinePlus (English) medlineplus.govmedlineplus.gov NIH SeniorHealth http://nihseniorhealth.gov/http://nihseniorhealth.gov/ NOAH: New York Online Access to Health

http://www.noah-health.org/http://www.noah-health.org/

http://mlanet.org/resources/medspeak/topten.htmlhttp://mlanet.org/resources/medspeak/topten.html


Quick Guide to Health Literacy: Quick Guide to Health Literacy: http://www.health.gov/communication/literacy/quickguide/

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2012)

Health Literacy is a wicked problem

Mālō! Haere Ra!

Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) 28

Questions ?Questions ?

& Answers? & Answers?

Health Literacy is a Health Literacy is a Nursing ‘wicked problem’!‘wicked problem’!


’’Alu a koē Alu a koē mo mo

ke fiemalieke fiemalie

Documents

1 Health Literacy: a Panacea or Killer? A relatively new concept! Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012) Health Literacy: The Innovative Panacea