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SAPC Hot Topic: the importance of ‘health literacy’ in primary care

Published online by Cambridge University Press:  20 March 2012

Gill Rowlands
Affiliation:
Institute of Primary Care and Public Health, London South Bank University, London, UK
Jo Protheroe*
Affiliation:
Senior Lecturer In General Practice, Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
*
Correspondence to: Dr Jo Protheroe, Senior Lecturer In General Practice, Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK. Email: j.protheroe@cphc.keele.ac.uk
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Abstract

Type
Networking
Copyright
Copyright © Cambridge University Press 2012

Introduction

For communication between doctors and patients to be effective, doctors need to share health information with patients in a clear and manageable way. This information can include the nature of a diagnosis, the risks and benefits of different treatments, how to take medications in a safe and effective way and actions those patients can take to improve their own health. Patients also need to know how to access, understand and make use of health services in ways that can promote and maintain good health.

The ability to access, understand and use health information, including being able to navigate health services, has been termed ‘health literacy’ (Institute of Medicine, 2004). It is recognised as an important determinant of health. People can be well educated and even very literate but still have low health literacy; however, it is more prevalent in people with low basic skills. Recent surveys in the United Kingdom show that the percentage of adults below the literacy level expected of an 11 year old is 16% in England (Department for Education and Skills UK, 2003) and 25% in Wales (Williams and Kinnaird, Reference Williams and Kinnaird2004).

Why does health literacy matter?

Patients with low literacy have poorer health outcomes. These include inadequate knowledge about health and the healthcare system, intermediate disease markers, measures of morbidity (e.g. diabetes (Powell et al., Reference Powell, Hill and Clancy2007) and asthma (Paasche-Orlow et al., Reference Paasche-Orlow, Parker, Gazmararian, Nielsen-Bohlman and Rudd2005)), and general health status (Dewalt et al., Reference Dewalt, Berkman, Sheridan, Lohr and Pignone2004). Lower health literacy is associated with poorer ability to take medicines appropriately and to interpret labels and health messages (Berkman et al., Reference Berkman, Sheridan, Donahue, Halpern, Viera, Crotty, Holland, Brasure, Lohr, Harden, Tant, Wallace and Viswanathan2011). There is also evidence of poor access and utilisation of health services, including both preventive services (Scott et al., Reference Scott, Gazmararian, Williams and Baker2002) and increased hospitalisation and use of emergency services (Berkman et al., Reference Berkman, Sheridan, Donahue, Halpern, Viera, Crotty, Holland, Brasure, Lohr, Harden, Tant, Wallace and Viswanathan2011). Doak et al. found that insufficient and inaccurate health knowledge and difficulty in assimilating new information interfered with patients’ ability to effectively communicate with healthcare professionals about cancer screening and the risks and benefits of treatment options (Doak et al., Reference Doak, Doak and Meade1996). Cancer patients with poor health literacy have been found to have a limited understanding of the benefits of screening and of knowledge of their symptoms (Davis et al., Reference Davis, Williams, Marin, Parker and Glass2002). Overall, this has an effect on their stage at diagnosis (Bennett et al., Reference Bennett, Ferreira, Davis, Kaplan, Weinberger, Kuzel, Seday and Sartor1998). If we could improve literacy and health literacy, this could contribute to reducing health inequalities.

The SAPC Health Literacy SIG

There has been a growing Special Interest Group (SIG) at the Society for Academic Primary Care (SAPC) for some time now, encouraging research and collaborations (see http://www.sapc.ac.uk/index.php/special-interest-groups/health-literacy). As a direct result of the support of SAPC, the ‘Health Literacy Group UK’ has grown out of the SIG – www.healthliteracy.org.uk.

This group is essentially an internet community but with regular opportunities to meet and share research, best practice and evidence.

Here are some highlights of recent and upcoming work from the group.

Research conference

On 10 June 2011 we held our first research conference at the Chancellors Hotel and Conference Centre, Manchester. The conference was sponsored by MSD and the Food and Drink Federation.

We had plenary sessions from national and international health literacy experts. Professor Don Nutbeam (Southampton University) discussed how the view of health literacy as an asset has evolved from the field of lifelong learning and how the evolution of the concept of health literacy is continuing to challenge and develop the speciality. Dr Rima Rudd (Harvard University) discussed the ‘triple jeopardy’ experienced by people with low health literacy: lower literacy and numeracy skills, membership of marginalised groups and poor employment prospects. She discussed how building skills, including health literacy skills, empowers individuals and communities. Dr John Comings (Boston), an international literacy academic, gave us the theoretical background on literacy and numeracy skills and how materials should be designed to reflect these. Our final plenary presentation was by Professor Richard Osborne (Deakin University, Australia), who discussed the challenges of measuring a concept that has multiple definitions and concepts.

In addition to the plenary presentations we ran two parallel oral presentation sessions and a poster session. It was great to see so much fascinating and high-quality research taking place in the field across a wide range of academic, service and community development areas.

The oral, poster and plenary presentations from the day are available for download at http://healthliteracy.org.uk/seminar-presentations-to-download

Health Literacy book

Another ‘first’ for the group is development of a book ‘Health Literacy in Context: International Perspectives’. As the health literacy group started to grow in 2008–2009, we recognised the extensive research undertaken by colleagues from other countries and wished to review this evidence base and, where appropriate, adapt and build on this work to improve health and health services. To address this we organised an international seminar with health literacy experts in the fields of health, education, economics, policy and community work. The seminar, which ran over three days, not only gave us the opportunity to hear the latest developments but also facilitated wide-ranging interdisciplinary and international discussions. These are captured in the book; chapters are being written by those who gave the presentations, and the ‘added value’ brought through the opportunity to view health literacy from different perspectives and contexts is being drawn out by the editors (Deborah Begoray, Doris Gillis and Gill Rowlands). The book will be published by Nova Science in early 2012.

Upcoming meetings

We continue to hold free one-day seminars across the United Kingdom. Details of all our meetings and registration are available on our website www.healthliteracy.org.uk

SAPC: Enhancing primary care through academic excellence

Find out more about the work of SAPC at www.sapc.ac.uk

References

Bennett, C.L., Ferreira, M.R., Davis, T.C., Kaplan, J., Weinberger, M., Kuzel, T., Seday, M.A. Sartor, O. 1998: Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. Journal of Clinical Oncology 16, 31013104.CrossRefGoogle ScholarPubMed
Berkman, N.D., Sheridan, S.L., Donahue, K.E., Halpern, D.J., Viera, A., Crotty, K., Holland, A., Brasure, M., Lohr, K.N., Harden, E., Tant, E., Wallace, I. Viswanathan, M. 2011: Health literacy interventions and outcomes: an updated systematic review. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
Davis, T.C., Williams, M.V., Marin, E., Parker, R.M. Glass, J. 2002: Health literacy and cancer communication. CA – A Cancer Journal for Clinicians 52, 134149.CrossRefGoogle ScholarPubMed
Department for Education and Skills (UK). 2003: The skills for life survey. A national needs and impact survey of literacy, numeracy and ICT skills. London.Google Scholar
Dewalt, D.A., Berkman, N.D., Sheridan, S., Lohr, K.N. Pignone, M.P. 2004: Literacy and health outcomes: a systematic review of the literature. Journal of General Internal Medicine 19, 12281239.CrossRefGoogle ScholarPubMed
Doak, L.G., Doak, C.C. Meade, C.D. 1996: Strategies to improve cancer education materials. Oncology Nursing Forum 23, 13051312.Google ScholarPubMed
Institute of Medicine 2004: Health literacy: a prescription to end confusion. Washington, DC: National Academies Press.Google ScholarPubMed
Paasche-Orlow, M.K., Parker, R.M., Gazmararian, J.A., Nielsen-Bohlman, L.T. Rudd, R.R. 2005: The prevalence of limited health literacy. Journal of General Internal Medicine 20, 175184.CrossRefGoogle ScholarPubMed
Powell, C.K., Hill, E.G. Clancy, D.E. 2007: The relationship between health literacy and diabetes knowledge and readiness to take health actions. The Diabetes Educator 33, 144151.CrossRefGoogle ScholarPubMed
Scott, T.L., Gazmararian, J.A., Williams, M.V. Baker, D.W. 2002: Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Medical Care 40, 395404.CrossRefGoogle Scholar
Williams, J. Kinnaird, R. 2004: The national survey of adult basic skills in Wales. Cardiff, UK: Basic Skills Agency, Welsh Assembly Government.Google Scholar
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