Health Navigator NZ

Health Literacy

Health literacy is the ability to read, understand and effectively use basic medical instructions and information.

For health providers “health literacy includes the capacity of professionals and institutions to:

• communicate effectively so that community members can make informed decisions and
• take appropriate actions to protect and promote their health.”        

“Only now do I know how profoundly the gap between knowledge and practice is widened by limited health literacy. Only now do I know why some refer to this as a “silent epidemic”—the lack of understanding by most professionals and policy makers of its extent and effect, and the individual shame associated with it that keeps it even more silent and hidden…” Chair of the 2004 IOM Report on Health Literacy

Definitions:

Health literacy is defined in Healthy People 2010 as: "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions".

“Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.” (Definition from National Networks of Libraries of Medicine)

Key Points: People with lower health literacy have poorer health outcomes (higher hospitalisation rates, higher health care costs and worse health status than people with adequate literacy) independent of socioeconomic and educational factors Low health literacy can affect anyone of any age, ethnicity, background or education level. Low health literacy can contribute to negative psychological effects and is often "hidden" to maintain dignity If we are serious about improving the health of our patients and community, then understanding health literacy and identifying strategies to improve it, needs to be prioritised. Over 50% of NZ adults are likely to experience health literacy difficulties (based on figures from the NZ Adult Literacy & Life Skills Survey 2006); therefore a focus on strategies to improve health literacy is essential

Why is health literacy important?

Health literacy is an essential life skill for individuals: It may help individuals seek and use information and take control over their health. Health literacy is a public health imperative: building health literacy improves overall population health. Health literacy is an essential part of social capital: low health literacy is a strong contributor to health inequalities.

Health literacy is a critical economic issue: and costs countries $billions every year.

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Overview of Health Literacy

For an introduction and overview on health literacy, try the following websites and resources:

• Health Literacy NZ.  -  An excellent new resource for the health sector from Workbase NZ
• Korero Marama - Health Literacy & Maori Report - results from the 2006 Adult Literacy & Life Skills Survey - shows Maori have pooer health literacy skills compared to on-Maori across all of the measured variables.
  • 80% of Maori males and 75% of Maori females were found to have poor health literacy skills.
  • Overall, New Zealanders have poor health literacy skills
• Easy to Read Patient Information - Medline Plus
• National Network of Libraries of Medicine (USA) - comprehensive section covering range of topics ranging from background, research findings to skills needed and additional resources/listservs.
• NZ Literacy Portal - The NZ Literacy Portal provides a useful source of information for anyone interested in adult literacy and related issues and this links to their health literacy section.
• Health Literacy - Medline Plus - excellent section on health literacy with wide range of links and resource

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Resources for Improving Health Literacy

Some excellent resources and programmes have been developed to help improve health literacy. (Note: most are from outside NZ)

• Ask Me 3 - this is an excellent health communication programme by the Partnership for Clear Health Communication at the National Patient Safety Foundation. There are a range of resources to view including:
• Ask Me 3 - What can providers do?
• What can organisations do?
• The 3 questions for patients to ask their doctor, pharmacist or nurse at every encounter to better understand your health

3  Good Questions: 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

 

Tools for improving health literacy from US Department of Health & Health Services:

• Quick Guide to Health Literacy
• Quick Guide to Health Literacy and Older Adults
• Toolkit for Trainers: Teaching Older Adults How to Find Health Information on the Internet
• Sample Action Plan to Improve Health Literacy for a fictious health organisation
• Presentation - PowerPoint Slides

Strategies for improving health literacy

From Quick Guide to Health Literacy, US Dept Health & Health Services

• Improve the Usability of Health Information
• Improve the Usability of Health Services
• Build Knowledge to Improve Health Decision-making
• Advocate for Health Literacy in Your Organization

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Training

• NZ Literacy Portal
• Health Literacy and Patient Safety Videoes – Help patients understand from the American Medical Association Foundation & University of Kanas - very useful

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Measurement & Assessment Tools for Health Literacy

• While a range of tools exist for assessing and measuring health literacy, we would recommend caution before introducing such a tool to your clinic. Poor health literacy is a societal issue and requires a whole of system and intersectorial approach. Rather than risk stigmatising people further, it is better to take a universal design approach and assume 50-75% of your population may have difficulties with health literacy at various times. Look at what you do, from signage and forms at reception through to communicating medication information, self-help instructions and contingency plans if they get worse or are not getting better.

• For those that are particularly interested in assessment tools, here are some links:
  • Assessing Reading Ability & Literacy Levels two-page Word document from the Ohio State University/AHEC Health Literacy Program describing seven strategies for assessing adult reading ability and literacy level. (Health Disparities Collaborative)
    
  • The Test of Functional Health Literacy in Adults, (TOFHLA) is a widely used health literacy assessment tool.
    • Advantages: good psychometric characteristicsand available in both English and Spanish,
    • Disadvantages: Time to administer limits it’s functionality in practice – full version (18 to22 minutes); short version (7 to 10 minutes)
    • Abstract
      
  • Newest Vital Sign Literacy Assessment Test - Rapid Estimate of Adult Literacy in Medicine - can be administered in less than 3 minutes, but only available in English. Abstract
  • PRISM - Programme for Readability in Science and Medicine
    • Prism Readability Toolkit - This 81-page toolkit is  a public-domain handbook for researchers illustrating how to use plain language in participant materials.
    • PRISM Online Training - an hour-long, Web-based plain language tutorial created especially for research professionals, including scientists, research staff, IRB administrators, or communications staff.
  • Better Tools for Multi-site research - Research Toolkit.org -  A toolkit for health research in partnership with practices and communities.  This website is organised around five typical phases of multi-site research from formation to close-out.  In each of these sections, you’ll find resources and tools that have been used in other research networks. They are offered here so that you don’t have to start from scratch.  Educational resources that span different aspects of the research process can also be found in the Training section.

 

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References & additional links

Korero Marama: Health Literacy and Māori. Ministry of Health, 2010.  www.moh.govt.nz/moh.nsf/indexmh/korero-marama-health-literacy-Māori -feb2010

Sanders LM, et al. Literacy and child health: a systematic review. Arch Pediatr Adolesc Med. 2009 Feb;163(2):131-40.

 Agency for Healthcare Research & Quality (2011). Health Literacy Interventions and Outcomes: An Updated Systematic Review. March 2011. US Department of Health & Human Sciences.  Available at: http://www.ahrq.gov/clinic/tp/lituptp.htm

 Board on Neuroscience and Behavioral Health (2004). Health Literacy: A Prescription to End Confusion. Institute of Medicine

 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Author.

Healthy People 2010 (very large file! Over 12 MB)

Johnson, K. Weiss, BD. How Long Does It Take to Assess Literacy Skills in Clinical Practice? J Am Board Fam Med 2008;21 211-214 [Abstract] [full text pdf]

Johnson A, Sandford J, Tyndall J. Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Database of Systematic Reviews 2003, Issue 4. Abstract

Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. 2003. Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 163(1): 83-90

Safeer RS, Keenan J. Health literacy: the gap between physicians and patients. Am Fam Physician. 2005 Aug 1;72(3):463-8. [Abstract] [Full article pdf]

 

LITERATURE REVIEWS

Dewalt DA, Broucksou KA, et al. Developing and testing the health literacy universal precautions toolkit.Nurs Outlook. 2011 Mar-Apr;59(2):85-94.

Coleman C. Teaching health care professionals about health literacy: A review of the literature.Nurs Outlook. 2011 Mar-Apr;59(2):70-8.

Hawkins AO, Kantayya VS, Sharkey-Asner C.Health literacy: a potential barrier in caring for underserved populations.Dis Mon. 2010 Dec;56(12):734-40. Review. No abstract available.

Easton P, Entwistle VA, Williams B. Health in the 'hidden population' of people with low literacy. A systematic review of the literature.BMC Public Health. 2010 Aug 5;10:459. Review.

Goldberg JP, Sliwa SA. Communicating actionable nutrition messages: challenges and opportunities.Proc Nutr Soc. 2011 Feb;70(1):26-37. Epub 2011 Jan 5.

Oldfield SR, Dreher HM. The concept of health literacy within the older adult population. Holist Nurs Pract. 2010 Jul-Aug;24(4):204-12. Review.

Levasseur M, Carrier A. Do rehabilitation professionals need to consider their clients' health literacy for effective practice? Clin Rehabil. 2010 Aug;24(8):756-65. Epub 2010 Jun 11. Review.

Bubalo J, Clark RK Jr et al. Medication adherence: pharmacist perspective .J Am Pharm Assoc (2003). 2010 May-Jun;50(3):394-406. Review.

Evangelista LS, Rasmusson KD, et al. Health literacy and the patient with heart failure--implications for patient care and research: a consensus statement of the Heart Failure Society of America. J Card Fail. 2010 Jan;16(1):9-16. Epub 2009 Dec 11. Review.

Wolf MS, Wilson EA et al. Literacy and learning in health care. Pediatrics. 2009 Nov;124 Suppl 3:S275-81. Review.

DeWalt DA, Hink A. Health literacy and child health outcomes: a systematic review of the literature. Pediatrics. 2009 Nov;124 Suppl 3:S265-74. Review.

Kountz DS. Strategies for improving low health literacy. Postgrad Med. 2009 Sep;121(5):171-7. Review.

Eichler K, Wieser S, Brügger U. The costs of limited health literacy: a systematic review. Int J Public Health. 2009;54(5):313-24. Epub 2009 Jul 31. Review.

 Driscoll A, Davidson P, Clark R, Huang N, Aho Z.Tailoring consumer resources to enhance self-care in chronic heart failure. Aust Crit Care. 2009 Aug;22(3):133-40. Epub 2009 Jul 5. Review.

Amalraj S, Starkweather C, Nguyen C, Naeim A. Health literacy, communication, and treatment decision-making in older cancer patients. Oncology (Williston Park). 2009 Apr 15;23(4):369-75. Review.

Peerson A, Saunders M. Health literacy revisited: what do we mean and why does it matter? Health Promot Int. 2009 Sep;24(3):285-96. Epub 2009 Apr 16.

Clement S, Ibrahim S, Crichton N, Wolf M, Rowlands G.Complex interventions to improve the health of people with limited literacy: A systematic review.Patient Educ Couns. 2009 Jun;75(3):340-51. Epub 2009 Mar 3. Review.

Sanders LM, Federico S, Klass P, Abrams MA, Dreyer B. Literacy and child health: a systematic review. Arch Pediatr Adolesc Med. 2009 Feb;163(2):131-40. Review.

Weld KK, Padden D, Ramsey G, Garmon Bibb SC. A framework for guiding health literacy research in populations with universal access to healthcare.ANS Adv Nurs Sci. 2008 Oct-Dec;31(4):308-18. Review.

Edwards M, Davies M, Edwards A. What are the external influences on information exchange and shared decision-making in healthcare consultations: a meta-synthesis of the literature. Patient Educ Couns. 2009 Apr;75(1):37-52. Epub 2008 Nov 25. Review.

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