Health literacy

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Health literacy

• Angela Coulter
• Picker Institute Europe
• www.pickereurope.org

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Topics

• About health literacy
• Uses of health literacy
• What works?
• Understanding illness, treatment and services
• Selecting appropriate treatment / support
• Managing long-term conditions
• Preventing illness, reducing inequalities

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About health literacy
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What is it?

• The ability to read, understand and act upon
  health information.
• Reading understanding competence to make
  health decisions
• Essential for patient engagement - relevant to
  whole population
• Critically important in tackling health
  inequalities requires targeted approach

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Levels of health literacy

• Functional
• Basic skills in reading and writing for
  understanding health information
• Interactive
• More advanced skills to enable active
  participation in healthcare choices
• Critical
• The ability to critically analyse information
  about health and healthcare and make effective
  use of it
• Nutbeam 2000

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People with low health literacy

• Have poorer health status
• Undergo more hospital admissions
• Are less likely to adhere to treatment
  recommendations
• Experience more drug and treatment errors
• Make less use of preventive services
• Institute of Medicine 2004

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Low literacy in the UK

• TOFHLA tests reading, numeracy and
  comprehension (e.g. instructions for taking
  medicines, exemption from prescription charges)
• 11 of UK adults had marginal or inadequate
  literacy
• Lowest levels among those who were
• Older
• Male
• Lower educational attainment
• Lower income
• Worse diet
• Less exercise
• Smokers
• Worse self-rated health
• Von Wagner et al J Epid Com Health 2007

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Understanding illness and treatment
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What patients want

• To understand what is wrong
• To gain a realistic idea of prognosis
• To make the most of consultations
• To understand tests and treatments
• To assist in self-care
• To find services and sources of help
• To find reassurance and help to cope
• To help others understand
• To learn how to prevent further illness
• To find the best healthcare providers

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Some patient information is not helpful

• Topics of relevance to patients omitted
• Failure to recognise patients decision-making
  role
• Incomplete coverage of treatment options
• Inaccurate and out-of-date
• Biased more about benefits than risks
• Uncertainties ignored or glossed over
• Coulter et al. BMJ 1999 318 318-322

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Information to support decision-making (IPDAS
criteria)

• Starts with a clear statement of aims
• Provides unbiased information about options
• Presents outcome probabilities clearly
• Contains accurate information
• Helps people make decisions
• Discloses conflicts of interest
• Has a clear structure and layout
• Helps the reader judge its reliability

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Understanding illness, treatment and services
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Health information sources (UK pop over 45)
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Doctor gave clear goals and treatment plan
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Doctor explained medication side-effects
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Use of health websites and telephone helplines by
social group
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Accessing information about health and social
care services

• Professionals do not systematically or
  proactively provide information about local
  services
• Lack of coordination between information
  providers
• Lack of effective signposting
• Telephone information not always useful or
  appropriate
• Some websites are poorly designed
• Information is often out-of-date
• Information not always accessible to all

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Understanding illness and treatment

• Best Buys

• Communications training for health professionals
• Longer consultations in primary care
• Personalised patient information
• Pre-operative and pre-discharge information
• Telephone helplines, telehealth

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Selecting appropriate treatment
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Would have liked more involvement in treatment
decisions (NHS patient surveys, England 2004/7)
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Doctor always gives information about treatment
choices and elicits patients preferences
Commonwealth Fund survey 2005
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Patient decision aids
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BPH treatment options

• Prostatectomy (open/TURP)
• TUNA/TUMT/TUIP
• Alpha blockers
• Reductase inhibitors
• Watchful waiting

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BPH appraising the options
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Selecting appropriate treatment

• Best Buys

• Decision aids for patients
• Patient access to records
• Patient-reported outcome measures (PROMs)

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Managing long-term conditions
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Care planning

• We are committed to ensuring that by 2010 all
  people (of all ages) with a long-term condition,
  including people with mental health problems, are
  offered their own personalised care plan. Care
  plans will be signed off by individuals and their
  lead professionals to provide a record of what
  has been agreed. This will help people take
  greater control of their care, on a more equal
  partnership with the health and social care teams
  that support this care.
• NHS Next Stage Review Our Vision for Primary and
  Community Care July 2008

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Patients with chronic conditions given a
self-management plan
Commonwealth Fund survey 2005
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Care planning for diabetes a process not a
piece of paper (Year of Care)
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Managing long-term conditions

• Best Buys

• Integrated disease-specific self-management
  education and support
• Lay-led self-management education
• Health coaching, telehealth

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Promoting health, reducing inequalities
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Advice received on weight, diet or exercise
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Promoting health, reducing inequalities

• Best Buys

• Opportunistic advice from health professionals
• Reminders and motivational phone calls
• Parenting programmes and home visits
• Dietary education and motivation
• Self-help information (print and electronic)
• Mass media campaigns

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Conclusions

• Health literacy matters
• People need information to help them make
  decisions
• Professionals underestimate information needs
• Staff training can be helpful
• Personalised information is best
• Self-care education and support should be
  integrated into care systems
• Websites and the telephone can be effective