The World Health Organisation’s (WHO) report Health literacy toolkit for low and middle-Income countries defines health literacy as:
“…the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health.”
Health literacy is a two-sided issue, comprising both an individual’s ability to understand and use information to make decisions about their health and care, and a ‘systems issue’, reflecting the complexity of health information and the health care system. There is a strong social gradient in the population, with lower levels of health literacy much more common among the socially and economically disadvantaged. In other words, if we don’t address health literacy, we run the risk of inadvertently widening health inequalities by developing information and services which do not meet the needs of those people who would benefit most from accessing them.
The impact for individuals with low levels of health literacy include:
- significantly more negative outcomes across a range of health indicators
- More likely to have unhealthy lifestyles
- less likely to make informed healthy lifestyle choices and engage with preventative programmes
- higher levels of illness and preventable premature mortality
- less able to manage long term conditions
- less likely to adhering to medication regimes effectively.
A Public Health England commissioned report Improving health literacy to reduce health inequalities (2015) highlights the extent of the health literacy challenge. It identified that up to 61% of the English working age population do not routinely understand health and wellbeing information they are given.
“the strongest correlation to ill health – stronger than education level, deprivation, age or ethnicity – is health literacy”.
In order to tackle this NHS England has set up a national collaborative to take a whole system approach to addressing health literacy. Three partners on the Collaborative (Health Education England, NHS England and Office for Health Improvement and Disparities) jointly supported a demonstration health literacy site in the East Midlands. Among the site activities was the delivery of Skilled for Health, which is the national, evidence based health literacy resource.
In addition, health information including a Health Literacy Toolkit is available for patients, their families and carers as well as the health and care staff supporting them.
The Patient Information Forum (PiF) has created a one-page infographic named Health Literacy Matters. This makes the case for the development of health literate information. It sets out the average UK skills for literacy and numeracy, the impact this has on health and what information producers can do to develop information that works for everyone.
There is also a 30-minute Health Literacy E-learning module available. By the end of the module, you will know why health literacy is important and how to use some simple techniques including TeachBack, chunk and check, using pictures and simple language to improve how you communicate and check understanding with others.
Improving the quality and accessibility of health information
The NHS has created a new standard for creating health content that outlines some essential requirements and best practice guidance for creating high quality health content. It is designed for any organisation that produces health and care information.
In addition, the Accessible Information Standard sets out how organisations should ensure that certain groups of people receive information in formats that they can understand and that they receive appropriate communications support to assist their understanding. Since August 2016 all publicly funded health and adult social care services, including hospitals and GP practices, have been required to meet the Accessible Information Standard.
The link between shared decision making and health literacy
Improving health literacy is a key influence on people’s health behaviours and, therefore, their health and wellbeing. This in turn has a benefit for the NHS as it reduces the demand each individual places on the health service.
Effective shared decision making improves health literacy by improving communication between professionals and patients, providing clear information and increasing patients’ knowledge. What is more, shared decision making has a positive disproportionate effect; it has a greater impact on those with lower health literacy or who are more disadvantaged so can also reduce health inequalities. However, it does mean that information needs to be provided to people in such a way that they can make sense of it for this benefit to be realised.
A key element of a shared decision making conversation is an assessment of the risks and benefits of various treatment and care options. Many people struggle with health statistics and risk. Shared decision making encourages a different type of conversation about risk i.e. personalised information needs to be tailored to individual circumstances and health literacy needs to be a key factor in this.
For further details on communicating risks, benefits and consequences, see the NICE guideline on shared decision making.
One technique that is very helpful in ensuring that patients have understood the information given to them, including risk information, is known as teachback. This is a health literacy evidence based communication technique, and the Personalised Care Institute (login required) has developed a helpful resource showing Teachback in action.