On World Health Day, 7th April 2022, Beth Cooper discusses the Importance of health literacy for the Hippocratic Post.
According to the Centres for Disease Control and Prevention, personal health literacy is ‘the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.’
This recent definition focuses on a persons ability to utilise health information rather than just understand it, therefore enabling well informed decisions to be made regarding their personal health, and the health of those around them. The COVID-19 pandemic threw the world into a whole new way of operating, in which the importance of understanding health related information was paramount. For the past few years, individuals globally have had no choice but to recognise and respond to health related information relayed by their governments, and people are increasingly being challenged to make important health and lifestyle choices in order to manage their personal journeys through complex health environments and situations.
Why is health literacy important?
Limited health literacy has negative connotations to both physical and mental health outcomes; with outcomes including a reduction in service utilisation, poor management of chronic conditions, misunderstanding of treatment and medication instructions, poor comprehension of medical management options, and a reduction in self reported health concerns.
The effects of poor health literacy has a drastic impact on public health outcomes and the global burden of disease, incurring astronomical cost, pressure on services, quality-adjusted life years, morbidity and mortality worldwide. Poor health literacy results in poor decision making surrounding health and lifestyle, poor health outcomes, poor self management, increased risk of hospitalisation, avoidable hospital visits and admissions, and an increase in risky decision making behaviours.
There is a wide array of research and evidence that suggests improved health literacy and self-management of clinical conditions improves health-related behaviours and results in improved clinical outcomes. Research studies have found an increase in patient involvement and understanding results in lower probability of hospitalisation, improved health-related quality of life, improved clinical indicators, more healthy behaviours, and a significant reduction in cost implications relating to health.
Improvements in health literacy have been identified to result in an increased use of preventative health services, improved ability to utilise health systems, improved understanding of treatment requirements, positive health outcomes, and lower rates of anxiety, pain, psychological distress and mortality.
Barriers to health literacy:
With increasingly diverse and aging populations, health literacy challenges are vastly expanding. Factors influencing an individual’s health literacy include poverty, education, race/ethnicity, age, and disability. Low health literacy is more prevalent amongst older adults, minority populations, and individuals with a lower socioeconomic status. It is important to recognise these barriers in order to address the gap between where we are now and where we need to be.
The importance of health literacy is not a new concept, patient engagement and understanding of health related concepts has been considered for many years. In 2018 The Kings Fund Shared their report ‘Responsibility for health: the cultural change we need.’ Outlining the importance of shared responsibility in health, and defining steps towards creating a harmonious relationship between patient and clinician, they state: ‘There is good evidence for people taking greater responsibility to manage their own health where they have the capabilities and motivation to do so. However, this must go hand in hand with equipping people with the knowledge and information that will support them to do this.’
So, who’s responsibility is health literacy?
The responsibility for health literacy is multi-dimensional, and many people will have many ideas on where the responsibility lies.
The government has a responsibility to promote health, as does health organisations, local authorities, charities, businesses, educators, community leaders, clinicians, employers, researchers, the media, and even the food and drink industry. Each have their own part to play in improving the health literacy of our society.
What about an individuals responsibility? According to the US Department of Education, only 12% of English-speaking adults in the US have proficient health literacy skills.
Throughout my clinical experience I have come across patients from all walks of life, some who have a very clear understanding of their individual health, but many who do not. Patients often have very little or no understanding of their own conditions, medications, allergies, and previous treatments or surgeries, which can often make continuity of care difficult, and can effect clinical outcomes.
The Picture of Health Report published in 2015 reported a number of key findings in relation to individuals perceptions of their own health responsibilities.
- 87 per cent of those asked agree that individuals should take responsibility for their health, however only 45% of participants reported that they actively manage their own health.
- 66 per cent of those who do not actively manage their own health believe they would benefit from doing so
- 80 per cent agreed that despite the continued focus on health, wellness and nutrition we are becoming less healthy as a nation
These findings show a clear gap between what individuals know they should be doing to prevent illness and what they are actually doing to actively manage their health.
An understanding of health related information starts with an individuals willingness to learn, to take in health related knowledge and gain an understanding on it. And although there are the aforementioned challenges to this, if addressed effectively, this is something which can ultimately have a positive effect on the health related outcomes of our society.
So, what is different now?
It feels like there has been a shift in recent health attitudes, with millennials having a growing concern over the burden of health, and utilising health applications and hand held devices to track this. And although the burden of disease is still rapidly growing, the concern for individual health seems to be growing alongside it, which could increase patient engagement and self management of health conditions.
How can we harness this recent shift in attitudes to elicit positive change?
As the trends for health concern seem to be growing with each generation, I believe we have a duty to educate. Further aspects of health studies should be part of the national curriculum, and although there have been recent improvements to the national health curriculum, I think this could be expanded upon. I believe it would be beneficial to teach first aid, CPR, common illnesses and symptoms, and also teach the correct access to health services in a dedicated lesson specifically focused on health and health behaviours.
Research suggests that students who participate in health education as part of their school curriculum have improved health related knowledge and attitudes, health literacy and skills, and it has a positive impact health promoting behaviours. If health education begins early and continues throughout a child’s development and growth, national objectives for health literacy, wellness and well-being can be achieved.
COVID-19 has focused the health industry on what can be achieved when digital innovation is adopted at scale, and many healthcare companies are waking up to how digital tools can help them to improve patient outcomes and provide a more holistic approach to patient care. Going one step further, could clinicians be encouraging their patients to utilise digital innovations such as apps and data tracking to improve the self management of their conditions as part of their ongoing management plans.
Condition journals and symptom tracking
The use of journaling to encourage wellbeing has recently come into the spotlight, with the benefits of improved memory, boosting mood and reducing stress. With the creation of condition specific journals where patients can actively track progress, treatment and symptoms, journaling as a self management technique and to improve health literacy and understanding can be utilised in relation to health outcomes. Could this be utilised in the health management process, with condition specific journals used during clinic appointments and as an aid for clinical assessment and improved understanding.
Shared Decision Making
This post is by no means placing the onus of health solely on the individual, instead it is highlighting the importance of working collaboratively and encouraging patient engagement, therefore improving health literacy. In my experience, patients often fail to retain or understand information provided to them regarding their own health conditions due to insufficient health literacy, and although there are challenges to patient involvement such as access to services and social inequalities, we need to start thinking outside the box in order to come up with ideas which may not yet have been tried.
The ideas suggested in this post outline ways in which patients can be given the tools to improve their individual health literacy, in order to encourage them to take ownership of their own health outcomes from the very beginning of their health journey, starting at school and continuing throughout their lives, and would hopefully give them the confidence to truly take ownership of their own health.
Centres for Disease Control and Prevention. (2022) https://www.cdc.gov/healthliteracy/learn/index.html
Stormacq, C., Wosinski, J., Boillat, E., Van den Broucke, S. (2020) Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review, JBI Evidence Synthesis: 18 (7); 1389-1469
Polster, Debra S. DNP, MS, APRN, CCRN, CCNS Confronting barriers to improve healthcare literacy and cultural competency in disparate populations, Nursing: December 2018 – Volume 48 – Issue 12 – p 28-33
Loan LA, Parnell TA, Stichler JF, et al. Call for action: nurses must play a critical role to enhance health literacy. Nurs Outlook. 2018;66(1):97–100.
US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. 2010. www.hhs.gov.
Philips (2015) The Picture of Health Report. [Online] Available at: https://www.philips.com/a-w/about/news/future-health-index/reports.html [Accessed 21/02/22]
Greene, J., Hibbard, JH., Sacks, R., Overton, V., and Parotta, CD. (2015) When Patient Activation Levels Change, Health Outcomes And Costs Change, Too. HEALTH AFFAIRS; 34(3).
Hughes, TM., Merath, K., Chen, Q., Sun, S., Palmer, E., Idrees, JJ., Okunrintemi, V., Squires, M., Beal, EW., and Pawlik, TM. (2018) Association of shared decision-making on patient-reported health outcomes and healthcare utilization. The American Journal of Surgery; 216(1), 7-12. https://doi.org/10.1016/j.amjsurg.2018.01.011.
Dineen-Griffin, S., Garcia-Cardenas, V., Williams, K., and Benrimoj, SI (2019) Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS ONE 14(8): e0220116. https://doi.org/10.1371/journal.pone.0220116
The Kings Fund (2018) Responsibility for health: the cultural change we need. https://www.kingsfund.org.uk/publications/shared-responsibility-health