Tag Archives: Health Literacy

Health literacy and health information literacy, and the role of librarians

by Caroline De Brún, PhD, DipLIS
October 2019

People of all ages, backgrounds, and education levels need health information, but often find it difficult to find and understand. Low literacy levels, in terms of reading, and being able to find, understand, and apply information, are a barrier to successful patient participation, and this is problematic, given the increasing recognition about the importance of engaging patients in the treatment decision-making process.

Health literacy and health information literacy are phrases that are becoming more widely used, sometimes interchangeably. However, there is a difference, and this post hopes to clarify the meaning of each.

Health literacy

Health literacy is the ability to understand instructions provided by health professionals. “In England, 42% of working-age adults are unable to understand and make use of everyday health information, rising to 61% when numeracy skills are also required for comprehension” (1), and “around one in five adults cannot read or understand simple instructions or labels such as those found on medicine bottles” (2, 3). The inability to read can result in patients taking medicines at the wrong times, not following dosages correctly, or not understanding instructions properly (4). For example, if the label on the prescription says “Take three tablets daily”, does this mean take three tablets at the same time or take one tablet three times a day? The quote in the box below, comes from a Facebook post written by a surgeon, and perfectly illustrates the consequences of misunderstanding medical instructions.

Health information literacy

Health information literacy, although often referred to as health literacy, has a more in-depth scope. It is not only about access to the Internet and online health information, but also about having the skills required by people to effectively recognise:

· what they need to know about their condition and treatment options,

· how to find that information, to fill those knowledge gaps,

· how to appraise the information to ensure it is good quality, and relevant to their personal context, and then

· how to use the information with their health professionals so that they can make an informed decision that suits their needs (5, 6).

Poor health information literacy can result in poorer health outcomes, unhealthy lifestyles, increased incidence of chronic conditions and mortality, greater use of emergency services, and increased hospital stays (1, 7-13).

Role of librarians

Maimonides, a Spanish philosopher said “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.” This quote reflects the importance of health information literacy, because if you find the information for the patient, their query will be satisfied, but if you teach them to search and appraise, they will be able to make informed decisions throughout their care pathways.

Health information literacy is an area where librarians, from all sectors, whether medical, public or academic, are in a strong position to support. They already have the resources, skills, and processes in place (14). Librarians can signpost people to the best sources, and teach them to search, retrieve, and appraise what they find (15). Medical librarians have the skills associated with evidence-based practice, as it is embedded in their roles, their primary function being teaching health professionals how to find and appraise the evidence. They also have access to the

relevant information sources, while public and school librarians are a trusted source within their communities, and understand the local context. Working in partnership would improve access to good quality health information at a location accessible to local people, who most likely would not have access to medical libraries.

People benefit from having access to good quality health information because it enables them to make informed decisions and follow their treatment regimens more effectively and safely (16-18). Informed patients are more likely to comply with the treatment regime, resulting in improved health, and reduced length of stay, and hospital admissions. Since the average doctor’s visit in England lasts 8-10 minutes (19), patients need to be ready to ask the right questions. Helping patients to self-manage by improving their health information literacy skills will benefit both the patient and the health system (1, 20, 21). By improving access to clear, current, accurate, and understandable consumer health information, health inequalities can be reduced and patients will feel more empowered (1, 22).

Creating health information literacy support programmes and resources is a new area for medical, public, and school libraries to work and lead on together. Library communities would benefit, in terms of professional development, more efficient working practices, and demonstrating value to the community. Patients could see improved health outcomes and better quality of life, health, and wellbeing, while health services might see a reduction in health service utilisation.

References:

1.           Treadgold P, Grant C. Making the case for information: Executive summary. London; 2013.

2.           Bostock S, Steptoe A. Association between low functional health literacy and mortality in older adults: longitudinal cohort study. British Medical Journal. 2012;344:e1602-e11.

3.           Glassman P, Almader-Douglas D. Health literacy Worcester, MA: National Network of Libraries of Medicine; 2013 [Available from: http://nnlm.gov/outreach/consumer/hlthlit.html.

4.           Koh HK, Berwick DM, Clancy CM, Baur C, Brach C, Harris LM, et al. New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly ‘crisis care’. Health Affairs (Project Hope). 2012;31(2):434-43.

5.           Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. Journal of the American Medical Association. 2002;288(4):475-82.

6.           Remshardt MA. The impact of patient literacy on healthcare practices. Nursing Management. 2011;42(11):24-9.

7.           Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine. 2011;155(2):97-107.

8.           Baker DW, Wolf MS, Feinglass J, Thompson Ja, Gazmararian Ja, Huang J. Health literacy and mortality among elderly persons. Archives of Internal Medicine. 2007;167(14):1503-9.

9.           Raynor DT. Health literacy: Is it time to shift our focus from patient to provider. British Medical Journal. 2012;344:e2188.

10.         Oliveira D, Bosco A, di Lorito C. Is poor health literacy a risk factor for dementia in older adults? Systematic literature review of prospective cohort studies. Maturitas. 2019;124:8-14.

11.         Dufour I, Lacasse A, Chouinard M, Chiu Y, Lafontaine S. Health literacy and use of healthcare services among community-dwelling older adults living with chronic conditions Clinical Nursing Studies. 2019;7(2):79-86.

12.         Fabbri M, Yost K, Finney Rutten LJ, Manemann SM, Boyd CM, Jensen D, et al. Health Literacy and Outcomes in Patients With Heart Failure: A Prospective Community Study. Mayo Clinic Proceedings. 2018;93(1):9-15.

13.         Balakrishnan MP, Herndon JB, Zhang J, Payton T, Shuster J, Carden DL. The Association of Health Literacy With Preventable Emergency Department Visits: A Cross-sectional Study. 2017;24(9):1042-50.

14.         Bragard I, Coucke P, Pétré B, Etienne A, Guillaume M. Health literacy, a way to reduce social health inequalities. Revue Medicale de Liege. 2017;72(1):32-6.

15.         Peterson G, Aslani P, Williams KA. How do consumers search for and appraise information on medicines on the Internet? A qualitative study using focus groups. Journal of Medical Internet Research. 2003;5(4).

16.         Vida Estacio E, Whittle R, Protheroe J. The digital divide: Examining socio-demographic factors associated with health literacy, access and use of internet to seek health information Journal of Health Psychology. 2019;24(12):1668-75.

17.         Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient Education and Counseling. 2016;99(7):1079-86.

18.         Pollock K, Grime J. GPs’ perspectives on managing time in consultations with patients suffering from depression: a qualitative study. Family Practice. 2003;20(3):262-69.

19.         The Royal Australasian College of Physicians. Towards a national primary care strategy: A discussion paper from the Australian government. Sydney; 2009.

20.         Panagioti M, Skevington SM, Hann M, Howells K, Blakemore A, Reeves D, et al. Effect of health literacy on the quality of life of older patients with long-term conditions: a large cohort study in UK general practice. 2018;27(5):1257-68.

21.         World Health Organization, editor Health promotion: Track 2 : Health literacy and health behaviour. 7th Global Conference on Health Promotion; 2009; Nairobi: World Health Organization,.

22.         Belcastro PA, Ramsaroop-Hansen H. Addressing the Antinomy Between Health Education and Health Literacy in Advancing Personal Health and Public Health Outcomes. 2017;87(12):968-74.

23.         Neal MRO, Geiger BF, Cellitti MA, Smith KH. Web sense: Assisting individuals with disabilities and caregivers to find online health information. Journal of Consumer Health On the Internet. 2012;16(3):295-306.

24.         SCONUL Advisory Committee on Information Literacy. Information skills in higher education. London; 1999.

25.         Akobeng AK. Principles of evidence based medicine. Archives of Disease in Childhood. 2005;90(8):837-40.

26.         Sackett DL. Evidence-based medicine. Seminars in Perinatology. 1997;21(1):3-5.

27.         Silberg WM, Lundberg GD, Musacchio RA. Assessing, controlling, and assuring the of medical information on the Internet quality. Journal of the American Medical Association. 1997;277(15):1244-45.

Health Literacy Month

October is Health Literacy Month. For the last 20 years, organisations across the world have used October as an opportunity to raise awareness of health literacy.

So what is health literacy?

Health literacy is the ability to access, understand, appraise and use health information to make health-related decisions. In the UK, we know from work by Gill Rowlands that 43% adults struggle with text-based health information; rising to 61% if the health information includes numbers as well as text.

Health and social care staff need to be aware of health literacy issues to support access to information. Techniques such as “teach back” and “chunk and check” can increase understanding and the ability of individuals to own decisions about their health and wellbeing.

What is the local impact? This Health Literacy Month we are launching borough-level data on health literacy levels, for textual content and for health information that includes both text and numbers. This is analysis provided by Gill Rowlands and academic colleagues at the University of Southampton. We hope that this dataset will enable you to raise the profile of the issue locally and to prioritise activity.

What can NHS library and knowledge services do?

NHS library and knowledge services are well placed to advise colleagues on techniques to support people with low health literacy, to sign-post to patient information materials and to provide training. The health literacy toolkit includes a range of resources and guidance on techniques. We are currently cascading training to library and knowledge services staff, with a suite of materials in development to use in 2020.

How can I use Health Literacy Month?

Health Literacy Month provides an opportunity to have conversations about health literacy. These may be conversations within your service, using the toolkit to assess how you might be more health-literacy friendly. Or, they may be conversations with colleagues in other departments, or with partner organisations. There are international resources available to help you to add profile to Health Literacy Month.

If you would like to share ideas, do get in touch. Ruth Carlyle, Ruth.Carlyle@hee.nhs.uk, Strategic Lead NHS library and knowledge services – East of England and Midlands

Applying the International Handbook of Health Literacy to health library and knowledge services

Personal reflections by Ruth Carlyle

The International Handbook of Health Literacy was published at the beginning of August 2019. Thanks to funding from the German Federal Ministry of Education and Research, the 740 page volume is available open access

The editors bring together a truly international set of papers in the 45 chapters. The volume is in four parts: research into health literacy, an overview of recent developments; programmes and interventions to promote health literacy; policy programmes to promote health literacy; and future dialogue and new perspectives.

As a collected work, the International Handbook of Health Literacy affirms the relevance of health literacy across a wide range of disciplines and ‘the potential that has been attributed to health literacy in order to understand, explain and tackle individual as well as group differences in various health outcomes’ (p. xxi). Despite this potential, there is no unanimously accepted definition or measurement of health literacy (p. xxii, 139). Most of the definitions also focus on the ‘literacy’ aspects of ‘health literacy’ rather than the ‘health’ aspects (p. 649).

In the closing chapter, Stephan Van der Bourke suggests that there are three types of strategy that can be applied to address low health literacy: better health communication; better health education for the general population; and creating health literacy-friendly settings (p. 706).

Considered from the perspective of library and information services, the specific references to libraries and librarians appear in the third section of the volume, on policy programmes to promote health literacy. It is notable that the most extensive references appear in Chapter 28 on the development and implementation of Making it easy and Making it easier as health literacy policies for Scotland. NHS Education for Scotland works with library and knowledge services across a range of sectors to improve ‘signposting to useful health information’ (p. 425) and identifies closer working with librarians as one of the areas for further development (p. 431). Librarians elsewhere are involved in supporting health literacy through training the healthcare workforce (National Network of Libraries of Medicine, United States, p. 499), embedding health literacy into research and practice (British Columbia, p. 447) and creating portals of resources (New Zealand, p. 508).

The multidisciplinary and international nature of the handbook provide a resource that emphasises the scale of low health literacy as an issue and the need for a shared approach working across disciplines. The individual chapters provide insights into research studies and the needs of specific audiences, such as children and older people. Themes through the volume provide evidence of the importance of improving the awareness and communication of healthcare professionals, signposting to high-quality health information for the public and creating health literacy-friendly environments. These reinforce the value of the roles that health library and knowledge services can play in health literacy.