Presentation to the Health Literacy Group UK Seminar ‘Improving health information to promote health literacy’ Gill Rowlands, Professor, University of Newcastle and Aarhus University, March 2015

1. Health literacy and health information
in England: how big is the problem?
Presentation to the Health Literacy Group UK Seminar
‘Improving health information to promote health literacy’
Gill Rowlands, Professor, University of Newcastle and
Aarhus University
March 2015
1

2. Acknowledgements
• Co-researchers / co-workers
Dr Jo Protheroe, Keele University
Dr Marty Richardson, University of Liverpool
Dr Paul Seed, King’s College London
Dr John Winkley, AlphaPlus
Dr Rima Rudd, Harvard University
• Funders: MSD
2

3. This presentation
• What are the levels of functional health literacy in England?
• What impact does this have on patients, the public, the NHS?
3

4. Levels of functional health
literacy in England
• Project funded by MSD: ‘Defining and describing the
mismatch between population health literacy and numeracy
and health system complexity’. Rowlands G, Protheroe J,
Winkley J, Seed PT, Richardson M, Rudd R. (Submitted for
publication)
• Sampled health materials commonly used to promote and
protect health, manage illness, prevent disease or navigate
services: 64 materials sampled
• The extent to which the sampled materials were
representative of materials in everyday use in the English
health service was rated by a panel of experts
4

5. Example: Bowel Cancer
Screening Kit

6. • The literacy and numeracy difficulty of materials were rated
against the English Skills Qualification Framework
• A competency threshold was identified: having the skills to
fully understand and use 70% of materials
• Data from the 2011 English national literacy and numeracy
survey, which tested people against the English Skills
Qualification Framework, were analysed to see what
proportion of the population had literacy and numeracy skills
below the competency threshold required to fully understand
and use the materials we had sampled.
6

7. NQF
level
Key stage
equivalent
At this LITERACY level an adult
understands
Entry
level 1
5-7 years Short texts with repeated language
patterns on familiar topics
Entry
level 2
7-9 years Short straightforward texts on
familiar topics and from familiar
sources
Entry
level 3
9-11 years Short straightforward texts on
familiar topics accurately and
independently
Information from everyday sources
Level 1 11-14
years
Short straightforward texts of varying
length on a variety of topics
accurately and Independently
Level 2 14-16
years
A range of texts of varying complexity
accurately and independently
Information of varying length and
detail
Material level
Population level
Skills
Qualification
Framework
Literacy

8. NQF
level
Key stage
equivalent
At this NUMERACY level an adult
understands
Entry
level 1
5-7 years Numbers and symbols in a simple
format
Entry
level 2
7-9 years Numbers, symbols, simple diagrams
and charts in a simple format
Entry
level 3
9-11 years Numbers, symbols, diagrams and
charts used for different purposes
and in different ways
Level 1 11-14
years
Straightforward mathematical
information, can independently
select relevant information
Level 2 14-16
years
Mathematical information used for
different purposes, can
independently select and compare
relevant information from a variety of
sources
Material level
Population level
Skills
Qualification
Framework
Numeracy

9. National Qualifications level: Literacy level 1 / Numeracy level 1
Key Stage Skill Equivalent Ages:
Literacy 11-14 years, Numeracy 11-14 years
Number (%) English adults 16-65 yrs. UNABLE to understand and use this:
21 million people (61%)
Example: Bowel Cancer
Screening Kit

10. National and regional picture: % of
adults aged 16-65 years for whom
health information is too complex
52
35
3538
40
41
44
44
46
National average
43%
Text (literacy)
component of
health materials

11. National and regional picture: % of
adults aged 16-65 years for whom
health information is too complex
66
55
5455
59
60
60
62
64
National average
61%
Text (literacy)
AND
Numeracy
component of
health materials

12. Gender Age Ethnicity
Birthplace First language Qualifications
Employment
status
Job grade Income
Home owner
Area
deprivation
level
Demographic characteristics of those at
highest risk of being below the health
literacy threshold
Male (literacy)
Female
(numeracy)
Aged 45+ BME
Born outside
of the UK
English not
first language
Below
expected by
age 16
Unemployed
Lowest job
grade
Income less
than £10,000
Not a home
owner
Top 5 most
deprived areas
Not statistically
significant when
considered
together

13. Impact on patients and the public: illness
People with lower health literacy :
• Have higher mortality (older people)1
• Have more difficulty managing medication1
• Have a higher prevalence of long-term conditions (LTCs)2
• LTCs more likely to be limiting2
• Are less likely to engage with disease prevention e.g. cancer
screening, immunisation1
13
1. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al.
Health literacy interventions and outcomes: An updated systematic review.
Rockville, MD: Agency for Healthcare Research and Quality., 2011 Contract No.: 11-E006.
2. HLS-EU Consortium: Comparative report of health literacy in eight EU member states.
The European Health Literacy Survey (HLS-EU). 2012

14. Impact on patients and the public:
wellbeing
People with lower health literacy / education level have
• More unhealthy behaviours; alcohol, poor diet/obesity2,3,
smoking3
• Fewer healthy behaviours; good diet/normal weight2,3
• Lower levels of self-rated health1,2
• Lower response to public healthy living campaigns3
14
1. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al.
Health literacy interventions and outcomes: An updated systematic review.
Rockville, MD: Agency for Healthcare Research and Quality., 2011 Contract No.: 11-E006.
2. HLS-EU Consortium: Comparative report of health literacy in eight EU member states.
The European Health Literacy Survey (HLS-EU). 2012
3. Buck D, Frosini F. Clustering of unhealthy behaviours over time. Implications for policy
and practice. . London: King's Fund, Aug 2012.

15. Conclusions
• Low health literacy is a problem for many
people in England.
– Nearly half the population (4 out of 10) cannot
fully understand and use health information, rising
to 6 out of 10 when the information contains both
text and maths.
– Some groups within the population, and some
parts of the country, face more difficulties than
others
15

16. Conclusions
• Low health literacy has a clear association
with poorer health and greater risk of illness
• Improving health information and health
communication can help to reduce the
problems brought through low health literacy
• In parallel we need to support the
development of health literacy skills,
particularly for those in the most
disadvantaged groups
16

17. Health literacy and health information
in England: how big is the problem?
Gill Rowlands
Gill.Rowlands@folkesundhed.au.dk
17