Better health - literacy is the best remedy

Better Communication - Better Health

 

Many people who deal effectively with other aspects of their lives find health information difficult to obtain, understand, or use. Patients are often faced with complex information and treatment decisions. International research has shown that patients who are better informed about their health have more effective consultations with their health care provider, are better informed about the medicines they are prescribed, are more likely to comply with their medication and as a result have improved health outcomes.

New Irish research in 2015, shows that Irish people want healthcare professionals to use less medical jargon:

  • Two in five (39%) Irish people are calling for doctors, nurses and pharmacists to use more understandable language and less medical jargon. This was followed by speaking less formally (22%) and taking more time to explain things (18%).
  • 17% of people surveyed said they had taken the wrong amount of medication on at least one occasion.
  • People aged 15 - 34 years were least likely to ask a doctor, nurse or pharmacist to explain things they don’t understand.
  • Embarrassment was ranked as the main reason for not seeking more information from a healthcare professional (24%).

 

What is health literacy and numeracy?

Health literacy and numeracy involves a person being able to understand basic health information whether they receive it in writing, in person or over the phone. It also involves a person having the knowledge to understand their options and make informed decisions about their own health.

People working in the healthcare sector play an important part in improving health literacy and numeracy by communicating more clearly and making information and services more accessible to patients.

 

The Crystal Clear Programme

The research was launched to coincide with the launch of the Crystal Clear Pharmacy and General Practice Programme developed by MSD and the National Adult Literacy Agency (NALA). The programme has been developed to recognise the critical role pharmacies and general practices play in helping patients understand their health issues and the steps they need to take to improve their health. A Crystal Clear Mark will be awarded to pharmacies and general practices that take account of the literacy and numeracy needs of their patients and regularly evaluates and consistently improves this. Pharmacies and general practices can apply for this Mark by completing an online audit at www.nala.ie/crystalclear

This programme will support pharmacists and general practitioners to improve their services ensuring important health information is better communicated and understood between health practitioners and their patients. This is an investment in better health outcomes for all people in Ireland.






 

 

NALA work in the area of health literacy

The National Adult Literacy Agency (NALA) has been at the forefront of this work, making the link between literacy levels in Ireland, which are below the OECD average, and the impact this has on people’s health.

NALA conducted research with people with literacy difficulties and they highlighted problems they had understanding health information. They also spoke of difficulties they experienced dealing with health professionals and understanding the language they use. NALA brought these findings to the attention of health policy makers, including politicians, and gradually built awareness of this concept. In more recent years our work has been supported by MSD who encouraged pioneering health practitioners to share their approaches to health literacy through a national awards process. This has greatly enhanced awareness amongst those working across the health sector as well as deepened our understanding of the need for a national health literacy policy. Ireland’s participation in the European Health Literacy Survey revealed that 40% of the population had low health literacy levels. An OECD study of Ireland showed that 1 in 6 of those aged 16-64 had low literacy levels and reported significantly higher levels of poor health than those with higher literacy scores.

Supported by compelling research, our efforts to get health literacy on the policy map were successful and health literacy is now situated in the new population health framework, Healthy Ireland, which creates opportunity for greater commitment to building health literacy levels across all our efforts to build a healthier Ireland.

So, our plan at NALA is to work closely with the Health Service Executive (HSE) and other stakeholders in the health sector to progress this area. Recently a National Health Literacy Advisory Panel was set up that consists of organisations working in healthcare who are interested in developing health literacy strategies in their own organisation and influencing a national health literacy policy. It is chaired by NALA and our main focus is to progress health literacy and make the Irish health service more literacy-friendly. 

Similarly, the concept of the Crystal Clear General Practice and Pharmacy Programme is one project we hope to run each year. The programme has been developed to recognise the critical role pharmacies and general practices play in helping patients understand their health issues and the steps they need to take to improve their health. A Crystal Clear Mark will be awarded to pharmacies and general practices where there is evidence of and commitment to providing a health literacy friendly service to patients. This requires taking account of the literacy and numeracy needs of patients and looking for ways to consistently communicate clearly.

From this programme new Irish Health Literacy research (mentioned above) was conducted which found that Irish people want healthcare professionals to use less medical jargon.

 

Why is this so important?

International research has shown that patients who are better informed about their health have more effective consultations with their health care provider, are more likely to comply with their medication and as a result have improved health outcomes.

In the wider context, good health literacy and numeracy means that you can:

  • make sound health decisions at home and in the community;
  • give informed consent to treatment and follow dosage instructions;
  • understand how to live with chronic health conditions;
  • have the skills and confidence to ask questions; and
  • navigate healthcare systems.

 

So how can we address these issues?

1. Healthcare Sector

Starting with those working in the health sector, it is about reflecting on how they communicate with their patients and checking its effectiveness. Here the point is not to assume just because you tell the person the information your responsibility is over. Have you been clear and explained any medical terminology?  Has the patient been asked to give you their understanding of what they have heard? Simple techniques have been developed and simple changes to how we communicate can make a huge difference.

NALA with the support of MSD has developed a new programme aimed at helping general practitioners (GPs) and pharmacists develop their knowledge and understanding of health literacy and apply that knowledge to how they communicate with their patients. NALA will supply an online audit tool so they can check their efforts and if successful will be awarded a crystal clear mark to display in their premises. This will give patients confidence that their health professional is paying attention to their communication and how well they are understood. This is a real and tangible action which delivers on the health literacy policy proposed within Healthy Ireland.

When looking at what needs to happen for the general public, there is a need to recognise the importance of developing literacy skills through reading and learning the new words associated with the health area. For some this is a life skill they can maintain and develop, for others assistance in developing health literacy will be required. This kind of support is available through local adult literacy centres situated throughout Ireland and available free, during the day and in the evening.

 

2. The Patient and General Public

There is more to health literacy than learning. We also must change our practice and be more confident in our communication with health professionals. Recent research has shown that people aged 15 - 34 years were least likely to ask a doctor, nurse or pharmacist to explain things they don’t understand. Embarrassment was ranked as the main reason for not seeking more information from a healthcare professional (24%).

There are three simple questions patients should ask of their doctor, nurse or pharmacist during every visit. These questions are:

1.    What is my main problem?

2.    What do I need to do?

3.    Why is it important for me to do this?

 

Be prepared and ask questions

Sometimes it’s difficult to remember everything you wanted to know or ask your doctor or health care worker. One way to avoid sometimes unsatisfactory health consultations is to be prepared. Write a note of any questions or concerns you have before your appointment so you don’t forget anything important.

And be sure to ask your healthcare provider to explain any complicated language in plain English.

 

Check your understanding

Often it is useful to check your understanding of what has been said to you by explaining the information back to your healthcare provider. That way they can be sure you understood the discussion and can correct anything you may have misunderstood.

Many people find health information difficult to understand and may be putting their health at risk. Communicating clearly and building health literacy will cost very little but will prove a vital investment in the health of Irish nation.

 

Previous NALA research

The need for research on health literacy in Ireland is highlighted in a NALA report from 2002 entitled, Health Literacy, Policy and Strategy.

This research shows that people have struggled with essential health information, consent forms, have not fully understood procedures, found signage confusing and did not feel capable of taking part in decision making. Fear is a big barrier to communication. True patient education is difficult to achieve among people with low literacy skills when there is such a reliance on the written word. This report also highlights examples of people finding it difficult and in some cases impossible to navigate their way around the health system. This research illustrates that health literacy means more than just reading information. It involves taking part in decision making and understanding options. Patients need time to review material. Health practitioners need to understand that one leaflet cannot accommodate the whole patient population.

Important actionable suggestions from this report include:

  • Irish research needs to be commissioned in areas of literacy training, communication, effects of low literacy skills on chronic illness etc…
  • A specific literacy research fund should be available to health and literacy practitioners, who should be obliged to publicise findings
  • Health literacy should be explored by the Health Service Executive.
  • All health promotion literature should be subject to literacy proofing.
  • All front line staff in hospitals and health centres should be literacy aware and be able to verbally convey information.
  • Professional jargon in forms, signs and health education material must be modified.

The results of a NALA Irish survey in 2007 revealed that:

  • One in five Irish people are not fully confident that they understand all of the information they receive from their healthcare professional.
  • Forty three percent said they would only sometimes ask for clarification if they did not understand something their healthcare professional said to them.
  • One in 10 people admitted taking the wrong dose of medication because of failure to understand instructions.
  • Two-thirds of respondents also admitted to having difficulty understanding signs and directions in Irish hospitals some of the time, with one in five stating they have difficulty most of the time.