Impacts of Health Literacy

Can you identify with any of these statements? Have you ever gone to the doctor or seen the nurse and had trouble understanding what was said at the medical visit, or have you gotten confused about how to take a prescribed medication? Have you ever had problems with completing a complex health assessment questionnaire? If you answered yes to any of those statements or question, then there is a possibility you have some health literacy issues.

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Health literacy is major determinant of health. It is defined as “personal characteristics and social resources needed for people to access, understand and use information to make decisions about health” (Brabers et al., 2018). Health literacy is referred to a source that is incorporated into patient’s daily lives. This includes information and decision-making skills that are necessary in a range of different contexts (Brabers et al., 2018). The focal point has changed from functional literacy like reading health information, to a broader viewpoint on elevated competences. With this being said, Don Nutbeam’s meaning of health literacy became significant. Don Nutbeam is a renowned public health expert. Nutbeam (2000; 2008) distinguish three different kind of health literacy. They are functional literacy, interactive literacy and critical literacy. Functional literacy is the necessary understanding of reading and writing. Interactive or communicative literacy is involving higher cognitive and literacy skills. These skills can be used in everyday live activities and these patients can apply new information to altering health conditions. Critical literacy is the most highly developed cognitive skills which can be practical to seriously information and to be used to have a greater control over life events and serious health situations. With critical literacy, an advanced knowledge of health literacy can help patients to interact in an array of ways at improve their health outcome.

Brabers article states that many studies looked at patient first choice towards being involved in making a medical decision. These studies showed that some patient prefer to leave major health decision to their healthcare professionals, others want to participate and give their opinion treatment options with these professionals. The idea that patients want to be part of the medical decision-making part of their healthcare is linked to a mixture of factors. Some of these factors include, the relationship with healthcare professionals, the kind of medical decision they need to make; the patients experience with the illness and medical care; the diagnosis and health condition. Some demographic characteristics, such as age, level of education and gender also plays an important role. Studies have shown women, younger adults, and higher educated patients choose a more vigorous role in their health care decision.

Health literacy (HL) according to another article is the degree to which individuals have capacity to obtain, process, and understand basic health information and services (Aoki and Inoue, 2018).

Health literacy is a public health problem globally. Nobody really thinks about it as being a public health problem, but it is. Statics has shown that the majority of people have some level of healthy literacy problems. Everyday people are going to see health professionals and leaving those visits just as confused or still not fully understanding what the doctor or nurse has said. This is leaving these patients and their health problems in limbo. Patients are more and more expected to be in control of their health. Patients are expected to be involved in making important decisions about their health and their healthcare. The reason for this is because of the ethical necessary for proper patient involvement about their health. Studies have shown that it is also beneficial for patient to play a larger role in their healthcare. Some of the benefits are the fact that it increases patient knowledge, it increases patient satisfaction with their treatment decisions, it reduces patient apprehension and patient will stick to their treatment plan better. In addition, providing patient care that is considerate, approachable, and have morals is a key component to good quality care.

If a patient can read, write and understand the health information given to them to better their health are considered to have a sufficient level of health literacy. Low health literacy mean people are not able to understand their health information nor have the ability to manage their health issues. Health literacy has a tendency to get worst with age, especially with adults age 65 and over. That is why most health literacy interventions should target patients before age 65. This will create good health literacy skills before they have any health issues that are connected with aging.

The topic of this review is health literacy. In this article the author states, that good management of many health conditions are contributed to patients understanding relevant information about their health. Having better support to patients with health literacy issues can also have a positive influence on their health. This is the reason why better methods should be used to help patients with low health literacy. This sets the framework for worldwide measures to improve the communications between health care professional and patients.

Health literacy has always been a major public health dilemma with over a third of Americans having difficulties understanding basic health information. A number of factors are related with health literacy and taking into consideration of rising healthcare costs, it is imperative that more assessment of ways to be aware of and diminish the impact of poor health literacy is necessary. Practical communication interventions with health professional, health organization and their patient can improve the care for people with low health literacy.

Assessing patient’s health literacy is of increasing concern for researchers and practitioners, given rapidly accumulating evidence that health literacy is correlated with health-related measures (Rawson et al., 2018). A large number of patients have health literacy issues, and many patients will not admit to having reading problems. The National Work Group on Literacy and Health (1998) warned health care professionals not to take for granted that they can recognize patients with health literacy problems. Research has shown that many health professionals rarely can identify patients with health literacy issues.

Health literacy is usually connected with loads of health disparities. The bond between the two still remains uncertain. Different assessment has been performed to get a better understanding to see how far the relationship between health literacy and health disparities has been thoroughly studied. The assessments will identify what possible relationships and ways have been discovered.

Challenges and strategies to improve patient health literacy is the topic of this literature review. Reading this review, it reports that 90 million adult Americans lack the literacy skills to effectively function in the current health care environment and this number has significantly improved over the past 10 years. Health Literacy is found in many different health care areas. Elderly patients, non-English speaking adults and low education level adults are the majority of people suffering from health literacy.

 Patient research studies in Australia, the United Kingdom and the United States have found that men have lower levels of health literacy skills than women (Davey, Holden and Smith, 2018). The numbers of chronic diseases in many societies are particularly high among men. The way of life and the risky behaviors are strongly associated with chronic disease progression amongst men. In numerous countries around the world, men tend to have less health knowledge and pay less attention to health prevention, than women. 

Poor health literacy is prevalent and is linked with many patients with major health problems. The descriptive pathways for this connection are complex. The reason people with poor health problems are associated with low health literacy is because the inadequate communication between health professional and patients. Having a good solution like a patient communication center, and a clear communication technique have proven a better health outcome with low health literacy. Teach back methods, and reinforcement, understandable health educational resources, illustration charts, comprehensible medication labels, tailored self-management support programs, and creating shame-free medical environments can help save lives also with patients that have low health literacy.

Health care professionals and health organizations are often oblivious of the extent of patient literacy, regardless of its important health implications. Healthcare providers have a tendency to misjudge their primary care patients’ health literacy level, and fail to recognize literacy as a risk factor for health outcomes. The author states there are a number of measures accessible to assess health literacy. Having basic terminology is a necessary requirement for understanding and applying health information.

Methods

Health literacy can be misunderstood in general. This has led to the rising effort to come up with a good solution to overcome the world health literacy problem.

In Reading all of the articles, the most used method of studying health literacy was by doing a questionnaires. All researchers who have done a study on health literacy gave patients with different levels of cognitive skills a series of questions to determine the outcome of their study. In one review, it talks about the two frequently used measures of assessing health literacy are the Test of Functional Health Literacy in Adults (TOFHLA, or the short version S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM). The two measures linked with one another and with various health-related measures, but the administration of these assessments have some limitations for use in clinical in a settings. The TOFHLA involves a written test that is self-administered and takes 22 minutes to complete; even though there is a shorter version, the S-TOFHLA, but it still usually takes roughly 7 minutes. The REALM only takes approximately 2 minutes to complete; nevertheless, it is not self-administered. The REALM consists of patients reading a list of words aloud, and a practitioner must be present to score accuracy.

The METER (Medical Term Recognition Test) is one of the newly developed, short, self-administered measures of health literacy. Patients are required to read a list of words and recognize which ones are real words. It takes 2 minutes to complete and was associated with the REALM test. A more up to date testing instrument, the Newest Vital Sign (NVS), has also been developed to assess health literacy levels. The NVS takes around 3 minutes to administer. The NVS assesses more than comprehension skills. It assesses math, reading, and abstract reasoning.

The NVS uses an ice cream nutrition label that the patient could hold and evaluate. Then six questions based on that label are read verbally. If the patient got 4 or more correct answers, this signified adequate literacy. If the patient got 2 to 3 answers correct, that signified limited literacy is possible, and none to one answers were correct, that showed the patient most likely had limited health literacy. The NVS showed sensitivity for recognizing limited literacy and modest specificity. But the NVS test was less successful than the S-TOFHLA for predicting health outcomes.

The authors of one review concluded that health care providers and health organizations should ask patients about their assurance to fill out medical forms, use of a stand-in person to help read health information, and their self-rated reading ability were all successful ways for acknowledging patients with limited health literacy. Testing for poor health literacy is easy and can be performed perfectly with one question. Health care professionals should be able to identify and react properly to patients with limited literacy, before testing for it.

Out of the studies using different testing devices met the criteria for poor literacy. For identifying patients with poor or insignificant health literacy, asking one simple question, “How confident are you in filling out medical forms by yourself?” This question is related with an answer of “a little confident”, “not at all confident”, “somewhat confident”, and “quite a bit” or “extremely confident”. A combination of screening questions and demographic information did not perform better than single item screening testing. The Newest Vital Sign was the most effective for ruling out inadequate or marginal health literacy, but drastically less practical than the single item measurement. The best quality of the Newest Vital Sign is that healthcare professionals can immediately see the difficulties patients could be having with understanding health information. It would be a wise decision if researchers would connect with everyday people, healthcare professionals and institutions when planning an intervention program or campaign to improve health literacy. Talking with everyone would ensure that more patients’ needs are being meet.

This review, in my opinion gave a valid study as to why health literacy is a problem among patients that have a comprehension issues. The author gave several results from different literacy screenings showing that if health professional would take some precautions from the beginning and identify patients with health literacy problems would result in better patient care, which in return would give a positive health outcome.

References

 

Brabers, A., Rademakers, J., Groenewegen, P., van Dijk, L. and de Jong, J. (2018). What role does health literacy play in patients’ involvement in medical decision-making?.Burdette HL, W. R. (2004). Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children. Prev Med, 57-63.

Aoki, T. and Inoue, M. (2018). Association between health literacy and patient experience of primary care attributes: A cross-sectional study in Japan. Danhong Chen, P. E. (2016). Food Environments and Obesity: Household Diet Expenditure Versus Food Deserts. American Journal of Public Health, 881-888.

Rawson, K., Gunstad, J., Hughes, J., Spitznagel, M., Potter, V., Waechter, D. and Rosneck, J. (2018). The METER: A Brief, Self-Administered Measure of Health Literacy. Ford PB, D. D. (2010). Limited supermarket availability is not associated with obesity risk among participants in the Kansas WIC program. Obesity(Silver Spring), 1944-1951.

Davey, J., Holden, C. and Smith, B. (2018). The correlates of chronic disease-related health literacy and its components among men: a systematic review.Morland K, R. A. (2006). Supermarkets, other food stores, and obesity: The Atherosclerosis Risk in Communities Study. Am J Prev Med. , 33-339.

Howard Wilsher, S., Brainard, J., Loke, Y. and Salter, C. (2018). Patient and public involvement in health literacy interventions: a mapping review.Powell LM, A. M. (2007). Associations between access to food store and adolescent body mass index. Am J Prev Med, S301-S307.

Zoellner, J., Hill, J., You, W., Brock, D., Frisard, M., Alexander, R., Silva, F., Price, B., Marshall, R. and Estabrooks, P. (2018). The Influence of Parental Health Literacy Status on Reach, Attendance, Retention, and Outcomes in a Family-Based Childhood Obesity Treatment Program, Virginia, 2013–2015.Slack T, M. C. (2014). The geographic concentration of US adult obesity prevalence and associated social, economic, and environmental factors . Obesity (Silver Spring), 868-874.

Lambert, M., Luke, J., Downey, B., Crengle, S., Kelaher, M., Reid, S. and Smylie, J. (2018). Health literacy: health professionals’ understandings and their perceptions of barriers that Indigenous patients encounter.

Loignon, C., Dupéré, S., Fortin, M., Ramsden, V. and Truchon, K. (2018). Health literacy – engaging the community in the co-creation of meaningful health navigation services: a study protocol.

Mantwill, S., Monestel-Umaña, S. and Schulz, P. (2018). The Relationship between Health Literacy and Health Disparities: A Systematic Review.Sturm R, D. A. (2005). Body mass index in elementary school children, metropolitan area food prices and food outlet density. Public Health, 1059-1068.