The way health systems and services are designed and delivered places high health literacy demands on patients and whānau.
What is health literacy?
Health literacy is about knowing how to:
- find your way around the many different parts of the health system
- know about healthy lifestyle choices
- understand your health condition, including what makes it better or worse
- know how to use your medicines safely
- give informed consent to medical procedures
- manage long-term health conditions well.
Historically, the language used to describe this gap between the information provided and the understanding of it by ordinary people implied the problem was with the person, not the health service providers. Individual people were described as having ‘poor health literacy’. This is known as ‘a consumer deficit focus’.
We now recognise that high literacy demands are placed on consumers.
The problem is now recognised as being that the way health systems and services are designed and delivered places high health literacy demands on patients and whānau.
- the complex ways health systems are organised
- the type of language used in resources provided to consumers
- the way healthcare providers talk to patients
- the lack of variety of resources (eg, not just written) and the monocultural nature of them (not reflecting Maori, Pasifika and other members of our communities, all in English, etc).
The Ministry of Health defines health literacy demands as tasks individuals and whānau need to do to get well and keep well, and those created at points of contact with health services. For example, tasks may include the following:
- arranging appointments – understanding a letter and its instructions, making a phone call to confirm, arranging time off work and transport to attend
- attending appointments – navigating an unfamiliar environment to find a service, interacting with reception staff, answering questions, providing a history and personal details, and understanding health practitioners’ instructions about tests, medications and follow-up appointments.
Health literacy review – a guide Ministry of Health, NZ, 2015
Why does this matter?
These high health literacy demands affect consumers’ ability to access health information, care and services, and affects all aspects of health: prevention, acute care, long-term conditions and public health. It affects people of all ages and socioeconomic status and means health consumers have more negative health outcomes than if information was provided to them in a way they could access and understand.
It is also an equity issue, because the groups most likely to not have health information, care and services provided to them in a culturally appropriate way are Māori and Pasifika health consumers, as well as consumer groups whose first language is not English, have a disability, use NZ Sign Language or are blind or visually impaired.
Health literacy can be described using deficit language or empowering language.
- He has poor health literacy/she has trouble understanding health information.
- Māori and Pasifika peoples have poor literacy skills.
- Low health literacy is a problem in our country.
- Health consumers have high health literacy demands placed on them by the health system and healthcare providers.
- There are barriers provided by the system to patients and whānau getting the information, care and services they need.
- Healthcare providers such as doctors and nurses are responsible for making sure that appropriate information is provided to consumers in a way that makes sense to consumers.
- Healthcare providers should check patients understand the information provided to them.
- Health service providers need to identify and remove any barriers to someone taking action on the new health information they have been given.
What can healthcare providers do to improve health literacy?
Healthcare providers have a responsibility to provide information, care and services in ways that meet the needs of health consumers, and they also need to help health consumers understand what they need to know to live healthy lives.
In terms of information, they need to:
- use plain language (written and spoken)
- provide information in different formats, such as videos, apps and tools
- use photos, illustrations, diagrams and other non-written aids to support written content
- translate information into multiple languages
- make NZ Sign Language videos.
However, the focus needs to extend beyond improving the written materials given to consumers and their whānau. Health literacy involves changing the healthcare environment and how knowledge is shared.
A health-literate health system reduces demands on people and builds health literacy skills of its workforce, and the individuals and whānau who use its services. It provides high quality services that are easy to access and navigate and gives clear and relevant health messages so that everyone living in Aotearoa New Zealand can effectively manage their own health, keep well and live well.
A framework for health literacy in Aotearoa New Zealand
In 2015, the Ministry of Health published a framework for health literacy to address some of the systemic issues creating barriers to health literacy.
“Because of the way health systems are organised, individuals and whānau can often face a series of demands on their health literacy ... A health-literate health system reduces these demands on people and builds the health literacy skills of its workforce, and the individuals and whānau who use its services. It provides high quality services that are easy to access and navigate and gives clear and relevant health messages so that everyone living in New Zealand can effectively manage their own health, keep well and live well.”
The Ministry of Health developed this framework because it is committed to a health system that enables everyone living in Aotearoa New Zealand to live well and keep well. Building health literacy is an important part of this, and the framework outlines expectations for the health system, health organisations and all the health workforce to take action that:
- supports a culture shift so that health literacy is core business at all levels of the health system
- reduces health literacy demands
- recognises that good health literacy practice contributes to improved health outcomes and reduced health costs.
The framework also identifies some success indicators that individuals and whānau can expect to see from every point of contact with the health system.
What happens if the health system places high literacy demands on people?
- Premature morbidity and mortality – health literacy has been shown to be an independent risk factor for poorer health, increased complications and hospitalisations and dying younger than one’s peers (American Medical Association).
- Poorer access to healthcare – difficulties with high health literacy demands can result in difficulty accessing healthcare, following instructions from a clinician and medication errors (Safeer, 2005).
- Safety – high health literacy demands affect people's ability to correctly take medicines (Davis 2006).
- Increased costs – low health literacy costs countries billions of dollars per year. In the US, this is estimated to be between $106 billion to $238 billion each year. This represents between 7–17% of all personal healthcare expenditure (George Washington University Medical Center School of Public Health and Health Services).
- Hidden problem – shame and embarrassment are very common responses for people who cannot meet high health literacy demands. People regularly report going to extraordinary efforts to hide and cover up any reading or comprehension difficulties.
- Patient experience – high health literacy demands contribute to higher rates of misunderstanding, mismatched care to patient preferences, poor patient experience and complaints.
- Consent, inequality issues and quality of care – the high health literacy demands of our health system have major implications for informed consent, health inequalities and reduced quality of care.
About health literacy Health Literacy NZ
Health Literacy NZ
Health literacy review – a guide Ministry of Health, NZ, 2015
A framework for health literacy Ministry of Health, NZ, 2015
Equity of health care for Maori – a framework Ministry of Health, NZ, 2014
Kōrero mārama – health literacy and Māori Ministry of Health, NZ, 2010
For more information about care planning, visit our dedicated Self-management Support (SMS) Toolkit website for health providers and healthcare staff.