Consumer Enablement Guide

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Health Literacy

Health literacy is how well individuals can access, understand and apply health information, so they can make good decisions about their health.

Evidence shows that poor health literacy is associated with poor health outcomes. It is also associated with high healthcare costs, high rates of hospital presentations and admissions, and a higher mortality rate among older people.1

To better engage people in their own healthcare, we need to improve their health literacy. Health literacy gives people the knowledge, attitude, skills and motivation to:

  • maintain their health
  • manage minor illnesses
  • find and use healthcare services
  • navigate the healthcare system
  • communicate with health professionals
  • improve their environment and conditions.

Measuring health literacy

Measuring health literacy can help you identify what interventions are needed for individuals and populations, and see whether they are effective. It can also help with problem-solving for people with complex conditions.

There are a number of basic measures that can be used to measure someone’s health literacy, including:

  • the three-item scanner tool, used in waiting rooms
  • the Newest Vital Sign tool, used during face-to-face consultations
  • CHAT, a conversational tool that provides a series of topics to discuss.2 3 4

These tools don’t always detect low health literacy, but their simplicity means they are suitable for use in routine practice. For a more comprehensive screening tool, try the Health Literacy Questionnaire or the European Health Literacy Survey Questionnaire.5 6

These tools are self-administered and can help you understand the health literacy needs and strengths of individuals and communities. The Health Literacy Questionnaire is particularly useful, as it is used in the Australian Bureau of Statistics National Health Survey to provide a benchmark for health literacy in Australia.

The Health Literacy Questionnaire

The Health Literacy Questionnaire is a formal assessment that includes nine questionnaires and a profile of strengths and weaknesses to inform healthcare providers. While it does not cover physical capacity, the Health Literacy Questionnaire can help healthcare services develop coordinated strategies and support particular groups of people, by adjusting the content and structure of programs to suit their needs.

Improving health literacy

Most health literacy programs focus on improving health communication between health professionals and consumers. To address a range of health literacy levels, it is recommended that multiple strategies are used. They may include:

  • improving the design and readability of written materials
  • providing education to help people understand their health condition
  • training staff in techniques such as teach-back, where the clinician asks the person what they have understood
  • encouraging people to have a support person with them in the consultation
  • developing strategies to improve communication, such as getting people to write down questions before their consultation
  • modifying health service environments and developing policies or frameworks to improve health literacy.

There are a number of factors that can affect health literacy, including cognitive and intellectual disabilities, low general literacy, language barriers and cultural differences. Individual definitions of health (such as social and spiritual aspects) and health preferences can also play a role in health literacy.

As such, health professionals and services need a high level of cultural competence to understand the needs of the individuals, families and communities they work with, find common ground and identify the best way to work together.

The role of health organisations

While strategies to improve health literacy are often focused on the individual, changes are required at an organisational level for them to be successful.

Health organisations have an important role to play in supporting health literacy, by:

  • understanding health literacy and its impact on healthcare
  • helping individuals and communities develop health literacy skills
  • keeping health routines and communication simple
  • regularly assessing comprehension using techniques like teach-back
  • improving cultural competence among staff
  • making sure written materials are in Plain English, with no jargon
  • using photos and images to convey information where appropriate
  • making access, signage, websites and phone systems easy to use
  • embedding health literacy in policy and practice.7 8

Organisations outside the health system (such as education, media, consumer and social welfare organisations) can also help improve health literacy.8

References

  1. Berkman ND, Sheridan SL, Donahue KE, et al. Low health literacy and health outcomes: an updated systematic review. Annals of internal medicine. 2011;155(2):97.
  2. Chew LD, Griffin JM, Partin MR, et al. Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population. Journal of General Internal Medicine. 2008;23(5):561-6.
  3. Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Annals of Family Medicine. 2005;3(6):514-22.
  4. Adams RJ, Appleton SL, Hill CL, et al. Risks associated with low functional health literacy in an Australian population. The Medical Journal of Australia. 2009;191(10):530.
  5. Osborne RH, Batterham RW, Elsworth GR, et al. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC public health. 2013;13(1):658.
  6. Sørensen K, van den Broucke S, Pelikan JM, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13(1):948.
  7. Brach C, Keller D, Hernandez LM, et al. Ten Attributes of Health Literate Health Care Organizations. [Discussion Paper]. Washington (DC): Institute of Medicine; 2012 [updated 2012 Jun; cited 2018 Jan 15].
  8. Australian Commission on Safety and Quality in Health Care. National Statement on Health Literacy: Taking action to improve safety and quality. Sydney: ACSQHC; 2014 [updated 2014 Aug 25; cited 2018 Jan 15].

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