This document summarizes a presentation on improving health literacy given by Dr. Anne Johnson.
Some key points from the presentation include: defining health literacy and outlining its importance; discussing challenges in improving health literacy for both health professionals and patients; and providing strategies to enhance communication and make health information more accessible for all. The presentation emphasized adopting universal precautions by ensuring all patients can understand health information, regardless of their literacy level.
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Anne johnson community engagement consultant sa
1. Health Literacy: “Opening Doors to Health and Wellbeing”
Conference.
Darwin, 9th September 2010.
Improving Health Literacy –
Challenges for Health
Professionals
Dr Anne Johnson, Community Engagement
Consultant, SA.
3. 1. Clarity of understanding of the meaning
of health literacy.
2. Improving health literacy in practice.
4.
5. 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
6. Health literacy is the capacity to make
sound health decisions in the context of
everyday life
Health–care
system Home + community
Health
Literacy
•Functional
•Interactive
Political
•Critical
Kickbusch, Maag 2006
7. Health Related Goal Examples of Tasks and Skills Needed
Promote and protect • Read, comprehend, and make decisions based on food and
heath and prevent product labels
disease • Find health information on the internet or in publications
Understand, interpret, • Analyse risk factors in advertisements for health products
and analyse health • Determine which websites contain accurate information
information • Understand the implications of health-related policies in order
to vote
Apply health information • Determine and adopt guidelines for increased physical
over a variety of life activity at an older age
events and situations • Read and interpret safety precautions at work
• Choose a health fund
Navigate the health-care • Know which services are available and the cost
system • Locate the health services and find one’s way in a busy
hospital
Actively participate in • Ask questions
encounters with health- • Make appropriate decisions based on information received
care professionals and • Work in partnership with care providers to manage chronic
workers disease
Understand and give • Comprehend required informed consent documents before
consent procedures or for involvement in research
Understand and • Request access to information
advocate for rights • 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
8. Kickbusch
based
on Nutbeam
Level of Health Literacy Individual Role
Advanced Critical Social
Health Thinking Support and
Critical & Pro-Active
Health Knowledge Networks
Analysis
Literacy
Interactive
Health
Literacy Empowerment Active
Functional Functional Basic Health
Health Literacy Knowledge Passive
Literacy
9. 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)
10. 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.
11. Cultural and language differences and
socioeconomic status interact with and
contribute to low health literacy.
12. ◦ Increase health literacy.
◦ Involve patients so that they can make
decisions about their care and plan their
lives.
◦ Provide care that is culturally safe.
13. 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.
14. 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.
15. Source: Institute of Medicine of the National Academies, 2004, Health Literacy. A prescription to end
confusion. Figure 2-2 page 34
16.
17. “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
18. 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.
19. 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)
20. 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)
21.
22. 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)
25. 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)
26.
27. 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
28. Media (particularly television).
Internet - www.essentialbaby.com.au.
Magazines - Practical Parenting.
Safety organisations.
Health professionals and health services.
Childcare, kindergarten and school.
30. 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
31.
32.
33. 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
34. 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.
35. 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.
37. 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.
38. 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.
39. 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).
40. 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
41. 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!
42. NHMRC (1999) How to present the
evidence for consumers: preparation of
consumer publications.
http://www.health.gov.au/nhmrc/publications/synopses/c
p65syn.htm
Victorian DHS (2000) Well written health
information: A guide.
http://www.health.vic.gov.au/consumer/downloads/dhs1
074.pdf
43. Better Information and Communication
Practices
http://fahcsia.gov.au/sa/disability/pubs/policy/Document
s/cds/bicp/default.htm
Communication Rights Australia (CAUS) –
communication tool for people with speech
and communication difficulties
http://www.caus.com.au
Communicating Positively. A guide to
appropriate Aboriginal terminology
http://www.health.nsw.gov.au/pubs/2004/pdf/aboriginal
_terms.pdf
44. 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.
45. 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?
46. 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.
47. 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
