improving health literacy - healthdirect€¦ · improving health literacy in health care settings*...

The University of Sydney

Improving health

literacy:

Better health outcomes

for patients and the

community

Healthdirect partner forum 2016

Professor Don Nutbeam

School of Public Health, Prevention

Research Collaboration, University of

Sydney


Staring at the beginning: Defining and measuring literacy

What is literacy?

– Functional literacy is defined as a tangible set of skills in reading and writing and the capacity to apply these skills in everyday situations

Why is literacy important?

– Literacy skills enable people to better develop their knowledge and improve their potential to achieve personal goals.

– Individuals are able to participate more fully in society and the economy.

– Literacy is both directly and indirectly related to health status


Literacy and Health

– Relationship between low literacy and a range of health related outcomes well established

– Some indirect effects related to employment and lifetime income

– Some direct effects of low literacy, individuals are*– less responsive to health education

– less likely to use disease prevention services, and

– less likely to successfully manage chronic disease

*Berkman N D, Sheridan SL, Donahue KE, Halpern DJ, Crotty. 2011. Low Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of Internal Medicine, 155, 97-107


Literacy and health

Literacy

Reading

Writing

SpeakingListening

Numeracy

Accessing

health

knowledge

Understanding

risk

Social

functioning/

statusCommunicating

with health

professionals

Medication

errors/

adherence

Completing

forms

Managing

diet


Literacy is context and content specific

– More accurate to talk about literacies for example:

– Financial literacy

– Science literacy

– Media literacy

– IT literacy (new literacy) and

– Health literacy


What is health literacy?

– Health literacy Health literacy can be described as the possession of literacy skills (reading and writing) and the ability to perform the knowledge-based literacy tasks (acquiring, understanding and using information) that are required to make health related decisions in a variety of different environments

– Health literacy describes 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 health.*

*Nutbeam D. Health Promotion Glossary (1999) Health Promotion International, 13(4): 349-364. 1999 (also -WHO/HPR/HEP/98.1)

See also Nutbeam D. (2001) Health Literacy as a Public Health Goal: A challenge for contemporary health education and communication strategies into the 21st Century. Health Promotion International, 15; 259-67


Health literacy is also context and content specific

- for example influenced age and stage in life

A young person making

decisions about food,

tobacco and alcohol use

A first time pregnant

woman and her partner

A person first diagnosed

with diabetes


Low health literacy is more common than you would expect:

Health literacy in Australia: ABS Survey 2006

Australian Bureau of Statistics: 4233.0 – Health Literacy, Australia 2006 (pub. 2008)

Health literacy skill levels

Skill levels 3, 4 and 5 represent adequate or better health literacy.

A person classified at level 1 or 2 has difficulty in understanding

simple medicine information - medication names, dosage and

administration frequencyconcerning dosage and frequency


Health literacy matters

– In a health care system where there is

– need for more effective prevention,

– commitment to patient centred care, and

– greater than ever dependence on successful patient self-management of chronic conditions.

– Lower levels of health literacy are much more common among the socially and economically disadvantaged, and among older citizens.

– Those with greatest need are generally least able to respond to the demands of the health care system.


Improving health literacy in health care settings*

Pre-existing health literacy -

Health-related reading fluency,

numeracy, prior knowledge

Organizational practice sensitive to

health literacy

*Nutbeam D. 2008. The evolving concept of health literacy. Social Science and Medicine. 67. 2072-78

See also Paasche-Orlow MK, Wolf MS. The causal pathway linking health literacy to health outcomes.

American Journal of Health Behaviour; 2007; 31 (Supplement 1): S19-26



Improved access to health care,

and productive interaction with

health care professionals

Tailored health/patient

communication and

education





health literacy






Improved clinical outcomes

Improved health literacyEnhanced capability for self management,

improved compliance

Improved access to health care,

and productive interaction with

health care professionals

Tailored health/patient

communication and

education





health literacy





What is being tried to improve the situation?

– Use of techniques to improve the quality of interaction between consumers and health care professionals

– Training to support more structured, systematic approach to identifying patients/consumers with lower health literacy

Carlyle et al (2011). Practical Strategies to Improve Communication With Patients. Pharmacy and Therapeutics. 36(9): 576–589.


Choose your words carefully


Images are also important

– A recent review* of self-management materials for chronic kidney disease patients found:

– 57% of visual aids contributed no meaning to the text

– 2% of visual aids contradicted meaning in the text

– 77% of visual aids had no caption

– A review** of the reading demands of commonly accessed web-sites directed at prevention of falls among older people found:

– Reading levels routinely exceeded skills of intended audience

– Web sites least accessible to those in greatest need

– Missed opportunities to communicate with consumers

*Morony, S., et. al. (in press). Health literacy demand of printed lifestyle patient information materials aimed at

people with Chronic Kidney Disease: Are materials easy to understand and act on and do they use meaningful visual aids? Journal of Health Communication

**Brooks C, Ballinger C, Nutbeam D, Adams JA Literacy Levels Required to Understand Regularly Accessed Falls Prevention Websites Aimed at the Public. Journal of Physical Therapy and Health Promotion 2013, Vol. 1. 1, PP. 8-14


5C Image Checklist

Clarity Is it easy to see what it is?

ContributionDoes it contribute or reinforce

meaning in the document?

ContradictionDoes this image contradict any

message communicated in text?

Caption Is a caption present?

Culture Is the image culturally appropriate?


Adopting and adapting interventions that work

– 2011Review reports on the outcomes of 38 intervention studies (Sheridan et al 2011*).

– Broadly consistent evidence that comprehension of health information and advice among individuals with low health literacy can be improved

– Requires modifications to communication, and mixed-strategy interventions (for example combining adapted communications with behavioural skills coaching)

– an emphasis on skill building, and delivery by a health professional.

– use of simplified text and teach-back methodologies that have been shown to be effective in other literacy interventions

– Delivers improved health outcomes including reduced reported disease severity, unplanned emergency department visits and hospitalizations.

* Sheridan et al. (2011). Interventions for individuals with low health literacy: a systematic review. Journal of Health Communication, 16(s3): 30-54.


Partnering to improve literacy and health literacy

– 2014 trial to teach health literacy

in adult education (TAFE) classes

– Environment where students can

practice health literacy skills e.g.

reading labels, question asking

– Community health providers (NSW

Health) can introduce local health

services in guest lectures

– Teachers help CHPs simplify

language

Morony et al (under review) Improving health literacy through adult basic

education: A qualitative study.

Further results forthcoming.


Teach-back – four steps to improving patience

adherence with medicine prescription*.

1. Clinicians must accept the burden of communication - “I

have covered a lot of information today and I want to make sure I did a good job of explaining this.”

2. The communication should focus on a specific behaviour “Can you tell me when and how you will take this medicine?”

3. The patient should be reassessed and instructions should be explained again in a different manner as needed

4. Clinicians should continue to explain until both they and the patient agree that the information has been understood.

*Carlyle et al (2011). Practical Strategies to Improve Communication

With Patients. Pharmacy and Therapeutics. 36(9): 576–589


Teach-back trial with Healthdirect

• National helpline for pregnancy and parenting

• First study to use Teach-back in a telephone helpline

• Key objectives to examine:

• Caller perceptions

• Health professional experiences

• Feasibility for rollout to other services

• Early results encouraging with regard to:

• feasibility,

• consumer satisfaction and outcomes


Conclusions – we should put into practice what we

know

– Health literacy fundamentally dependent upon levels of basic literacy in the population.

– The impact of low health literacy is socially distributed, business as usual will simply exacerbate existing inequalities

– Achieving improved outcomes requires more –

– modifications to communication, and mixed-strategy interventions (for example combining adapted communications with interactive behavioural skills coaching)

– use of simplified text and teach-back methodologies that have been shown to be effective in other literacy interventions

– Delivery by a health professional may require enhanced education and training.

– Service organisation and delivery needs change and adaptation to be sensitive to low health literacy


The endThank you

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