Health Literacy

Health literacy has been defined as:

“The ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course” (Rootman & Gordon-El-Bihbety, 2008, p. 11).

Health literacy facts:

• 60% of Canadian adults and 88% of adults over the age of 65 do not have the skills needed to obtain, understand and act upon health information and services to adequately manage their health and health-care needs.

• Canadians with low levels of health literacy are two and a half times more likely to be in poor health and receiving income support.

• Low health literacy contributes to higher health-care costs and affects the social and economic health of Canadians.

• A high level of everyday literacy does not necessarily mean a high level of health literacy.

• Health-related materials often exceed average reading ability.

(Canadian Council on Learning [CCL], 2008)

Why does health literacy matter?

Canadians with low levels of health literacy are more than two-and-a-half times more likely to be in poor health and receiving income support as those with high levels (Canadian Council on Learning, 2008).

Access and amount of health information

Health information is available from many sources and it can often be contradictory. Canadians need to be able to critically assess the sources and understand and interpret the information. Furthermore, as new information about population health issues comes to light, old knowledge needs to be unlearned and new facts learned (Canadian Council on Learning [CCL], 2008).

System strains and increased costs

System-wide changes, including early discharge from hospital, require Canadians to be well-informed, active participants in their own health. Canadians with low levels of health literacy are at risk of chronic illness and preventable diseases (CCL, 2008).

In addition, people with low levels of health literacy and who already suffer from chronic disease know less about how to manage their illness than people with high levels of health literacy (Nielsen-Bohlman, Panzer & Kindig, 2004).

Lower health literacy leads to the ineffective use of services, poorer health due to lack of understanding of health problems and treatment, and increased frequency of hospitalization (Baker et al., 2002, as cited in Nielsen-Bohlman, et al, 2004, p. 7).

Aging population

Of Canadians over the age of 65, only 12% – or one in eight – are considered to be health literate. As Canada’s population ages, this fact becomes increasingly important as seniors suffer from more chronic diseases and take more medications than other age groups. (Rootman & Gordon-El-Bihbety, 2008).

Who is at risk from lower health literacy levels?

Health illiteracy is present across all societal groups and people; however, certain people are more at risk than others.

The highest risk people are:

• people over age 65, recent immigrants and those with low income and low education (Canadian Public Health Association, 2011)

• Aboriginal Peoples, many of whom have less than a grade nine education (Rootman & Ronson, 2005);

• people of diverse cultures; those whose primary language is other than English or French (Rootman & Gordon-El-Bihbety, 2008);

• people who are unable to read and write; (Rootman & Gordon-El-Bihbety, 2008) and

• people with learning disabilities (Rootman & Gordon-El-Bihbety, 2008).

Canadian strategies to improve health literacy

The Expert Panel on Health Literacy, formed in 2006 and led by the Canadian Public Health Association, recommends an integrated, cooperative, coordinated and comprehensive pan-Canadian strategy on health literacy be developed (Rootman & Gordon-El-Bihbety, 2008).

The Expert Panel on Health Literacy identified what features and policies a health literate Canada would provide as part of their vision statement:

• “national, provincial, territorial, aboriginal and local governments with opportunities to develop and improve health literacy throughout the life span (early childhood, childhood, adolescence, adulthood and older age);

• comprehensive policies and programs to reduce inequities in health literacy and health care access among Canadians;

• collaborative efforts by the health, social service and education systems and by the governmental, not-for-profit and private sectors to promote and facilitate health literacy;

• a culturally relevant and respectful approach to delivering health services and information;

• clear information about health and the operation of services and systems that affect health in a variety of languages;

• policies and incentives to encourage service providers and educators to facilitate health literacy in their interactions with clients, students, other community members and patients; and

• individuals with the confidence, support and skills they need to promote and advocate for the health of themselves, their families and communities.”

(Rootman & Gordon-El-Bihbety, 2008, p. 23)

Reading every day keeps the doctor away!

Reading every day – regardless of the subject matter or education level – has been shown to improve health literacy.

Did you know that one of the most important determinants of health literacy is daily practice reading?

Reading can be done at home or at work, from the Internet, books, newspapers or any other form of text (Canadian Council on Learning, 2008).

Nurses’ roles

Nurses often take the lead in providing health information to their clients and, according to Erlen (p. 150), “nurses are in a unique position to identify gaps in their patients’ understanding of their health needs.” If nurses ignores health literacy issues and do not identify those at risk, the risk is increased as clients may not understand the information they are given.

Studies have found that for many patients, written patient information is difficult to understand (Wilson, 2001). Therefore, when nurses provide health-care information, they need to take into account patients’ reading levels and ability to apply the information to activities of daily living.

As patient advocates, nurses must identify patient literacy issues as well as those who are at the greatest risk – such as seniors, who rely heavily on medication and health services and are “among the least literate groups in society” (Rootman & Ronson, 2005, p. S67).

The following are ways nurses can assist patients in understanding health information:

• Provide increased access to health information via new technologies, with a decreased reliance on print sources (Rootman & Ronson, 2005).

• Ensure patient written teaching materials are at a level appropriate to the patient receiving them, and that instructions are clear (Gilboy & Kunz Howard, 2009).

• Do not rush when providing teaching or instructions. Patients perceive non-verbal behaviour of a nurse who is rushing and may not ask questions or clarify information (Gilboy & Kunz Howard, 2009).

• Calm the environment. A crowded, noisy, unfamiliar environment makes understanding and remembering new health information difficult (Gilboy & Kunz Howard, 2009).

• Assess whether your patient is ready to focus. Pain, anxiety or medication side-effects can make focusing on health teachings or instructions difficult (Gilboy & Kunz Howard, 2009).

• The clock counts… Patients may be in a rush, especially when being discharged from hospital, and they may not take the time to ensure they understand instructions. Start health teaching and assessment of health literacy at the first point of patient contact (Gilboy & Kunz Howard, 2009).

• Ensure health teachings are provided in a context appropriate to the patient’s culture and language (Nielsen-Bohlman, Panzer & Kindig, 2004).

Where do you fit?

What level of health literacy do you rate yourself and your clients?

Levels of literacy

“The Organisation for Economic Co-operation and Development defines the following five levels of literacy:

• Level 1 – Very poor literacy skills. An individual at this level may, for example, be unable to determine from a package label the correct amount of medicine to give a child.

• Level 2 – A capacity to deal only with simple, clear material involving uncomplicated tasks. People at this level may develop everyday coping skills, but their poor literacy makes it hard to conquer challenges such as learning new job skills.

• Level 3 – Adequate to cope with the demands of everyday life and work in an advanced society. It roughly denotes the skill level required for successful high-school completion and college entry.

• Levels 4 and 5 – Strong skills. An individual at these levels can process information of a complex and demanding nature.”