INTEGRITY  HEALTHCARE  CONSULTANTS  

HEALTH  LITERACY  Fact  Sheet  #1  

FACT  SHEET    #1  

 

HOW HEALTH LITERACY IS MEASURED

The measurement scales typically used to assess health literacy in adults in Canada and the United States include:

• International Adult Literacy Skills Survey (IALSS)

• Rapid Assessment of Literacy in Medicine measure (REALM)

• Test of Functional Health Literacy in Adults (TOFHLA).

WHAT  IS  HEALTH  LITERACY?  The  ability  to  understand  and  communicate  health  information  is  essential  to  making  informed  decisions  about  our  health  care  needs.  Health  literacy  refers  to  a  person’s  capacity  to  “access,  understand,  evaluate  and  communicate  information  as  a  way  to  promote,  maintain,  and  improve  health  in  a  variety  of  settings  across  the  life  course”  (CPHA,  2008,  p.  11).  

Health  literacy  involves  a  range  of  interrelated  skills,  including:  

• Reading  and  comprehending  health  resources  • Understanding  instructions  from  health  care  

professionals  about  one’s  health  management  • Navigating  through  the  health  care  system  • Communicating  effectively  with  healthcare  

professionals    

 

DID  YOU  KNOW…  

It is estimated that only one in eight adults in Canada (12%) over the age of 65 “appears to have adequate health literacy skills.”

Source: Canadian Public Health Association, 2008, p.15

LOW  HEALTH  LITERACY:  WHO  IS  AFFECTED?  Aging  populations:  Age  is  an  important  determining  factor  in  one’s  level  of  health  literacy  skills,  often  because  literacy  skills  decline  as  we  age.  As  well,  older  Canadians  tend  to  have  lower  levels  of  literacy  and  education  than  younger  generations  (CPHA,  1998).      Immigrant  populations:  Health  literacy  tends  to  be  lower  among  immigrant  populations,  and  particularly  among  recent  immigrant  groups  whose  mother  tongue  is  not  English  or  French  (PHA  of  BC,  2012;  CPHA,  2008).    Low/precarious  income  recipients:  Socioeconomic  status  can  also  be  a  factor  in  one’s  level  of  health  literacy  skills.  Research  has  shown  that  individuals  scoring  below  average  on  health  literacy  scales  are  more  likely  to  be  receiving  income  support  (CPHA,  2008).  

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Lorem Ipsum

LOW  HEALTH  LITERACY:  WHAT  ARE  THE  IMPLICATIONS?  

 

“Given  that  chronic  ill-­‐health  is  the  leading  cause  of  death  in  Canada,  with  more  than  75%  of  all  deaths  attributable  to  one  of  five  chronic  diseases—  cancer,  heart  disease,  diabetes,  kidney  disease  and  respiratory  disease—the  positive  health  and  lifestyle  implications  for  improved  health  literacy  are  potentially  far-­‐reaching.”  

-­‐Public  Health  Association  of  BC  (2012).  An  Inter-­‐sectoral  Approach  for  Improving  Health  Literacy  for  Canadians,  p.  4.  

Low  health  literacy  limits  a  person’s  ability  to  manage  chronic  health  conditions,  use  health  care    resources  effectively,  and  access  appropriate  health  care  services.  As  such,  it  can  have  significant  effects  on  health  outcomes  and  health  care  costs.        

Health  outcomes:  Low  health  literacy  has  been  linked  to  medication  errors,  preventable  hospital  visits,  poor  health  care  management,  and  even  mortality.  Poor  health  literacy  can  also  affect  one’s  prevention  and  self-­‐management  of  chronic  health  conditions  such  as  heart  disease  and  diabetes  (PHS-­‐BC,  2012).    

Accessibility:  Health  literacy  is  fundamentally  about  consistent  access  to  appropriate  health  resources  and  services.  Limited  health  literacy  can  have  implications  for  a  person’s  awareness  of  available  health  care  services  within  the  community,  as  well  as  a  person’s  effective  use  of  health  resources.  For  example,  low  health  literacy  can  affect  an  individual’s  ability  to  read  and  follow  medical  instructions,  understand  medical  consent  forms,  and  keep  track  of  appointments.      

Costs:  Low  health  literacy  can  have  serious  implications  for  health  care  costs.  Research  has  shown  that  in  2009,  low  health  literacy  in  Canada  resulted  in  approximately  8  billion  a  year  in  health  care  costs  (PHS-­‐BC,  2012.)  

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  BARRIERS  TO  HEALTH  LITERACY  Individuals  with  limited  health  literacy  face  a  range    of  individual  and  systemic  barriers  to  developing  their    literacy  skills.      

Individual  barriers  can  include:  

• Low  levels  of  formal  education  • Age    • Language  proficiency  (particularly  if  one’s    

mother  tongue  is  not  English  or  French)  • Emotional  stresses  or  shame  associated  with  asking  health  professionals  for  clarification  or  guidance  

Systemic  barriers  can  include:  

• Conflicting  or  unclear  healthcare  information  (particularly  web-­‐based  information  sources)  • Lack  of  access  to  language  programs  for  persons  whose  mother  tongue  is  not  English  or  French  • Complex  health  care  and  hospital  services  that  make  it  difficult  for  individuals  to  navigate  the  system  • Differing  communication  styles  of  health  care  professionals  • Limited  access  to  health  information  (e.g.,  the  “digital  divide”  between  those  who  can  and  cannot  access  

web-­‐based  health  resources)  • A  mismatch  between  reading  levels  of  health  information  (e.g.,  informed  consent  forms)  and  the  literacy  

levels  of  the  readers  • Unclear  health  information  that  does  not  provide  for  a  comprehensible  plan  for  one’s  self-­‐care  regimens  

(CPHA  1998;  2006;  2008,  Nutbeam,  2000;  PHA-­‐BC,  2012)  

WE  CAN  HELP.  An  Integrity  Healthcare  Consultants  Case  Study:  

“Mrs.  V”  had  a  stroke,  leaving  her  unable  to  swallow  safely  enough  to  give  her  food  by  mouth.    She  was  admitted  to  hospital  in  need  of  an  alternate  method  for  feeding,  otherwise  she  would  become  malnourished  and  dehydrated.  Mrs.  V’s  daughter,  who  acted  as  her  substitute  decision  maker,  was  given  options  to  choose  from,  but  different  doctors  were  saying  different  things.    Conflicting  healthcare  information  is  a  common  barrier  for  patients  and  their  families.  Mrs.  V’s  daughter  was  confused  and  very  concerned  that  she  would  make  the  wrong  decision.      We  met  with  Mrs.  V’s  daughter,  provided  her  with  relevant  research  on  her  different  options,  and  discussed  what  she  felt  would  be  the  best  alternate  feeding  for  her  mother  in  her  current  condition.  Although  it  was  a  difficult  decision  to  make,  she  felt  relieved  that  she  had  taken  the  time  to  retain  our  services  and  get  the  education  that  she  needed  to  make  the  choice  that  she  felt  was  right  for  her  mother.  

 

HEALTH  LITERACY  AND  AGING  POPULATIONS  

 

What  does  low  health  literacy  mean  for  Canada’s  aging  population?  Research  has  shown  that  seniors  with  limited  literacy  skills  often  face  unique  challenges  in  terms  of  accessing  and  using  health-­‐related  information.      

Consequences  for  health  management:  Limited  health  literacy  can  have  implications  for  how  well  seniors  are  able  to  follow  prescription  instructions  or  comply  with  treatment  plans.  In  many  cases,  older  patients  are  reluctant  to  seek  clarification  from  healthcare  professionals  about  appropriate  prescription  use.  The  Canadian  Public  Health  Association  notes,    “when  low-­‐literacy  seniors  fail  to  take  their  medications  as  prescribed,  it  is  often  because  they  misinterpret  or  forget  the  medication  instructions  and  can’t  decipher  or  understand  the  information  on  the  label”  (CPH,  1998,  p.  3).    

Health  literacy  and  shifting  age-­‐related  needs:    As  literacy,  learning  styles  and  cognitive  skills  change  over  time,  many  older  adults  need  health-­‐related  information  designed  to  accommodate  their  shifting  needs.  Research  suggests  that  older  adults  prefer  health  information  that  is  concise,  straightforward  and  not  excessively  technical  (CDC,  2009).    

Aging  populations  and  the  digital  divide:  Increasingly,  consumers  are  expected  to  adapt  to  digital  e-­‐health  tools  in  their  own  healthcare  management.  This  demands  a  basic  knowledge  of  web-­‐based  information-­‐seeking  skills  that  are  not  always  accessible  to  many  seniors.      The  “digital  divide”,  a  term  used  to  describe  unequal  access  to  communication  technologies,  can  be  a  considerable  barrier  for  seniors  with  limited  literacy.    

 

“While  many  seniors  remain  healthy  and  happy  well  into  their  senior  years,  illness,  disability,  deteriorating  faculties,  isolation,  declining  mobility  and  diminished  independence  are  facts  of  life  for  others.  The  daily  struggle  to  make  sense  of  the  written  and  spoken  word  makes  it  even  harder  for  those  with  low  literacy  to  deal  with  such  difficulties.”  

 -­‐Canadian  Public  Health  Association,  1998,  p.  3.  

WE  CAN  HELP.  An  Integrity  Healthcare  Consultants  Case  Study:  

“Mr.  C”  is  83  years  old  and  had  been  hospitalized  for  several  weeks.    With  the  diagnoses  of  dementia,  his  family  was  worried  about  how  he  would  transition  from  the  hospital  to  home  in  the  care  of  his  wife.  Our  geriatric  specialist,  Mellissa  Turzansk,  went  to  Mr.  C’s  home  to  assess  him  and  review  his  medications.  She  observed  that  Mr.  C  had  transitioned  well  to  his  home  environment  but  was  very  unsteady  on  his  feet,  restless,  and  unable  to  sleep  well.    When  Melissa  reviewed  Mr.  C’s  medication  schedule  she  saw  two  medications  being  taken  together  that  would  cause  an  accumulated  effect,  putting  Mr.  C  at  a  high  risk  of  falling.  She  also  noted  that  a  multivitamin  was  being  taken  with  a  thyroid  medication.  This  was  a  problem  because  iron  in  the  multivitamin  decreases  the  efficacy  of  the  thyroid  medication.  Melissa  provided  suggestions  to  the  family  to  correct  these  two  concerns.  We  followed  up  with  Mr.  C  a  week  later  and  were  told  that,  based  on  our  advice,  he  had  his  medication  altered  by  his  family  doctor.  The  family  was  happy  to  report  that  Mr.  C  was  steady  on  his  feet  and  able  to  sleep  through  the  night.  

 

HEALTH  LITERACY  AND  PERSONAL  EMPOWERMENT  

 “By  improving  people’s  access  to  health  information  and  their  capacity  to  use  it  effectively,  health  literacy  is  critical  to  empowerment.”    -­‐World  Health  Organization    

 There  is  little  doubt  that  health  literacy  is  essential  to  effectively  managing  one’s  health  care  needs,  making  informed  decisions,  and  ensuring  that  one’s  access  to  health  resources  is  consistent  and  equitable.      Although  health  literacy  is  mediated  by  a  number  of  factors  including  systemic  barriers,  age,  educational  levels,  language  skills  and  socioeconomic  status,  individuals  can  begin  to  take  basic  self-­‐empowering  steps  in  managing  their  health  care  needs.      The  Canadian  Public  Health  Association  advises  that,  for  aging  populations  in  particular,  declining  health  literacy  skills  can  be  managed  by  engaging  daily  in  a  range  of  literacy  activities  such  as  reading  books,  newspapers  and  magazines  (CPHA,  2008).  The  Manitoba  Institute  for  Patient  Safety  suggests  that  individuals  can  become  more  actively  involved  in  their  health  care  management  by  consistently  asking  care  providers  three  simple  questions:      What  is  my  health  problem?    What  do  I  need  to  do?    Why  do  I  need  to  do  this?  

SOURCES  Canadian  Public  Health  Association  (1998).  Working  with  Low-­‐literacy  Seniors:  Practical  Strategies  for  Health  Providers.  Ottawa,  ON.      Centers  for  Disease  Control  (2009).  Improving  Health  Literacy  for  Older  Adults:  Expert  Panel  report.  Atlanta:  US  Department  of  Health  and  Human  Services.      Canadian  Public  Health  Association  (2008).  A  Vision  for  a  Health  Literate  Canada:  Report  of  the  Expert  Panel  on  Health  Literacy.  Ottawa,  ON.      Nutbeam,  D.  (2000)  Health  Literacy  as  a  Public  Health  Goal:  A  Challenge  for  Contemporary  Health  Education  and  Communication  Strategies  into  the  21st  Century,  Health  Promotion  International,  Vol.  15,  no.  3,  259-­‐276.  

Manitoba  Institute  for  Patient  Safety  (nd).  Retrieved  from:  http://www.safetoask.ca/  

Public  Health  Association  of  BC  (2012).  An  Inter-­‐sectoral  Approach  for  Improving  Health  Literacy  for  Canadians:  A  Discussion  Paper.  Victoria,  BC.      

World  Health  Organization  (nd).  Track  2:  Health  Literacy  and  Health  Behavior.  Retrieved  from:  http://www.who.int/healthpromotion/conferences/7gchp/track2/en/  

Prepared  by:  MacMillan  Research  Design  –  www.macmillanresearch.com