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HEALTH LITERACY FOR HEALTHCARE PROFESSIONALS

by Madalina Saracutu

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Objectives At the end of this presentation, you will be able to:

v  demonstrate a basic understanding of the concept of health literacy.

v  communicate the importance of health literacy to colleagues and patients.

v  identify specific ways to integrate health literacy into your work.

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Overview v  What is health literacy and why is it important? v  How does health literacy relate to health outcomes?

v  Measurement v  Integrating health literacy into your work

v  Advocacy v  Future research v  Resources

v  References

Early definitions More recent definitions “The ability to apply reading and numeracy skills in a healthcare setting.” (USA National Adult Literacy Survey, Kirsch et al.,1993)

“The ability of individuals to access and use health information to make appropriate health decisions and maintain basic health.” (Murray et al.,2007)

“ A constellation of skills, including the ability to perform basic reading and numeracy skills required to function in a healthcare environment.” (Ad Hoc Committee on Health Literacy, 1999)

“The ability to access, understand, evaluate, and communicate information as a way to promote, maintain and improve health in a variety of settings across the life course. ” (Rotman & Gordon- El- Bihbety, 2008)

4 What is Health Literacy?

5 Levels and domains (Nutbeam, 2000)

v  Functional health literacy- basic reading and writing skills necessary to function effectively in the healthcare context

v  Interactive health literacy- development of personal skills in a supportive environment aiming to improve personal capacity

v  Critical health literacy- ability to critically evaluate and use information to actively participate in health promotion

Why Is Health Literacy Important?

Navigating the healthcare system

Sharing personal and health information

Self-care Chronic disease

management

Adopting health-promoting behaviours

Acting on health related information

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Fig.2 Causal pathways between limited health literacy and health outcomes (Paasche-Orlow & Wolf, 2007)

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Evidence v  De Walt et al.(2004) - patients with low HL tend to have poorer

health outcomes; follow-up: children with low HL had worse health behaviours and outcomes (De Walt & Hink, 2009).

v  Sanders et al.( 2009)- after adjusting for SES, adults with low HL 1.2-4 times more likely to exhibit health behaviours that negatively affect children’s health

v  HL associated with adherence- low HL may cause difficulties with identifying medications or interpret prescription labels (Kolm & Jacobson, 2006)

v  Patients with low HL tend to be reluctant to seek assistance due to the stigma and shame (Baker & Pitkin,1996)

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“I had some papers, but I didn't know they were prescriptions and I walked around for a week without my medication. I was ashamed to go back to the doctor, but a woman saw the papers I had and told me they were prescriptions. It's bad to not know how to read. After getting my medicine I had to come back and ask how to take them because I was urinating too much. They told me I was taking double the medication I was supposed to. I had two bottles and I was taking one from each bottle, but it turned out they were the same medication. But since I don't know how to read, I didn't know “

Dalton (2006)

Measurement

v  Rapid Estimate of Adult Literacy in Medicine (REALM)- Davis et al.,(1993)

v  Wide Range Achievement Test (WRAT) - Jastak & Wilkinson (1993)

v  Test of Functional Health Literacy in Adults (TOFHLA)- Parker et al., (1995)

v  The Newest Vital Sign (NVS) - Weiss et al.,( 2005)

v  Literacy Assessment for Diabetes (LAD) – Nath et al., (2001)

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11 Sample REALM test

Practical task: Administering REALM

test

What does REALM test assess? Can you identify any issue with this test?

Issues with measurement

v  HL measures based on functional literacy do not capture the full range of skills needed for HL

v  Current assessment tools cannot differentiate among:

–  Reading ability –  Lack of health-related

background knowledge –  Lack of familiarity with

language and materials –  Cultural differences in

approaches to health.

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13 Strategies to improve communication and health literacy

v  Slow down

v  Use plain, non-medical language

v  Show or draw pictures

v  Limit the amount of information

v  Test for readability (Word ,“Show readability statistics” )

www.readability-score.com

v  Use the “teach-back” technique

v  Create a shame-free environment:

v  Consider using the Ask-Me-3 program:

What is my main problem?

What do I need to ?

Why is it important for me to do this?

Make a case for improving health literacy

v  Identify specific programs and projects affected by limited health literacy.

v  Target key opinion leaders with health literacy information:

�  Explain how health literacy improvement relates to your mission, goals, and strategic plan.

�  Circulate relevant research and reports on health literacy to colleagues

�  Post and share health literacy resources.

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Advocating literacy for all

v  776 mill. adults who lack basic literacy skills, 516 mill. women

(EFA, 2008)

�  Unequal access to literacy coexists with other social vulnerabilities

�  e.g. US risk of low literacy: indigenous communities, immigrants, racial and ethnic groups, 65+ with limited schooling, low-income communities (Marks, 2009)

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The six Dakar goals � 

� The Dakar Framework for Action, Education for All: Meeting our Collective Commitments adopted by the World Education Forum (Dakar, Senegal, 26 –28 April 2000), Paris, UNESCO, 2000.

Future directions

v  Expanding health literacy Scales

v  More research on the application of health literacy in other contexts (workplace, schools, advocacy)

v  Development of community-based creative approaches to promote health literacy

v  More rigorous evaluations

and evidence of good practice on health literacy

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“Health Literacy: Learning is the best medicine” http://www.youtube.com/watch?v=qRO2fjfqVrs

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Health Literacy: Healthy Living 1-day Conference at Keele Hall, Keele University

Friday 20th June 2014

Join us for our 3rd Annual National Health Literacy Research Conference

Health literacy is ‘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’.

We have plenary sessions from national and international health literacy experts, including Dr Michael Wolf (Northwestern University, Chicago) Dr Kristine Sorensen (Maastricht University) and Prof Gill Rowlands (Kings College, London).They will present their view on the current evidence, impact and future implications of Health Literacy Research on Healthy Living, from their respective international perspective of the US, Europe and the UK.

We welcome applications for oral presentation or posters on Health Literacy research and development or innovative and exciting Health Literacy practices.

The abstract submission guidelines are available from the website www.healthliteracy.org.uk or from Sue Weir (s.weir@keele.ac.uk).

Abstract deadline 5pm 21st February 2014.

Delegate rate for full day including tea, coffee and lunch £90. Please contact Sue Weir as above.

Dr Joanne Protheroe Conference Chair Co-Chair Health Literacy Group UK Keele University Staffordshire ST5 5BG E:j.protheroe@keele.ac.uk www.healthliteracy.org.uk

We are currently in negotiation with the Journal of Communication in Healthcare for a special issue to cover the conference presentations.

For more information about the Journal, visit www.maneypublishing.com/journals/cih

Keynote speakers

Professor Michael Wolf - Professor of Medicine and Learning Sciences, he founded and continues to lead Northwestern’s Health Literacy and Learning Program (HeLP). He is a health services researcher and cognitive/behavioral scientist with expertise in adult literacy and learning in healthcare, patient education, medication safety and adherence, and the use of health technologies to support chronic disease self-management.

Dr Kristine Sorensen - is a health literacy expert and project coordinator of the European Health Literacy Project (HLS-EU) hosted by the Department of International Health at Maastricht University. Other related projects are the Collaborative Venture on Health Literacy and the Diabetes Literacy Project supported by the European Commission.

Professor Gill Rowlands - is a health literacy expert at Kings College, London. She recently led a large national (UK) project examining the health literacy skills of the population and the health materials that they are expected to make use of.

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Useful resources �  http://www.healthliteracy.org.uk/ �  http://www.pifonline.org.uk/topics-index/producing/health-

literacy/

�  http://www.wun.ac.uk/research/wun-global-health-literacy-network

�  http://www.cdc.gov/healthliteracy/

�  http://www.hrsa.gov/publichealth/healthliteracy/

�  Health Literacy: Prescription to End Confusion (2004) Lynn Nielsen-Bohlman, Allison M. Panzer, David A. Kindig, Editors, Committee on Health Literacy

References �  Baker, D.W., Pitkin M.V (1996) the healthcare experience of patients with low literacy. Archive of Family Medicine, 5,

329-334.

�  DeWalt DA, Berkman ND, Sheridan SL, Lohr KN, Pignone M. Literacy and health outcomes: a systematic review of the literature. Journal of General Internal Medicine. 2004; 19(12): 1228 –1239.

�  De Walt D.A. & Hink A. (2009) Health literacy and child health outcomes: a systematic review of the literature. Paediatrics, 124, s265-274.

�  “Health Literacy: Learning is the best medicine”. (2010). [Video] Toronto:

�  http://www.youtube.com/watch? V=qRO2fjfqVrs.

�  Kirsch, I., Junglebut, A., Jenkins L., Kolstad, A. (1993) Adult literacy in America: A first look at the results of the National Adult Literacy Survey. Washington DC: National Center for Education Statistics, US Department of Education.

�  Murray S., Rudd R., Kirsch I., Yamamoto K., Grenier S. (2007) Health literacy in Canada, initial results from the International Adult Literacy and Skills Survey, Ottawa: Canadian Council on Learning.

�  National Assessment of Adult Literacy (2003). National Center for Education Statistics (NCES)

�  https://nces.ed.gov/naal/

Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies in the 21st century. Health Promotion international, 15, 259-267

�  Paasche-Orlow, M.K & Wolf M.S. (2007) The causal pathways linking health literacy to health outcomes. American Journal of health Behaviour, 31, S19-26.

�  Sanders L.M., Federico S., Klass P., Abrams M.A. & Dreyer B. (2009) Literacy and child health: A systematic review. Archive of Paediatric and Adolescent Medicine, 163, 131-140

�  UNESCO (2000). Wef (NGO consultation). [Online]

�  Retrieved from: http://www.unesco.org/education/wef/en-conf/dakframeng.shtm [Accessed: 6 Mar 2014].

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