Health Literacy: information literacy for life - Ruth Carlyle - LILAC 2019 Keynote address
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Health Literacy: information literacy for life - Ruth Carlyle - LILAC 2019 Keynote address
- 1. Health literacy: information literacy for life April 2019 @NHS_HealthEdEng Ruth Carlyle Head of Library and Knowledge Services & Technology Enhanced Learning, Midlands and East
- 2. What are the issues in health and care? Workforce https://www.hee.nhs.uk/our-work/strategic-framework
- 3. What role(s) health information?
- 5. Health literacy “The personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health” WHO 2015 Both system and personal roles to: – Access – Understand – Appraise – Use https://gateway.euro.who.int/en/themes/health-literacy/
- 6. 52 35 3538 40 41 44 44 46 National average 43% not understanding Text (literacy) component of health materials Slide taken from Presentation to the Health Literacy Group UK Seminar ‘Improving health information to promote health literacy’ Gill Rowlands, Professor, University of Newcastle and Aarhus University , March 2015 Scale: literacy element (16-65 years) 6Rowlands et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/26009533
- 7. 66 55 5455 59 60 60 62 64 National average 61% not understanding Text (literacy) AND numeracy component of health materials Slide taken from Presentation to the Health Literacy Group UK Seminar ‘Improving health information to promote health literacy’ - Gill Rowlands, Professor, University of Newcastle and Aarhus University , March 2015 Scale: literacy and numeracy (16-65 years) 7Rowlands et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/26009533
- 8. Health literacy in Germany Estimated cost of 9-15 billion Euros to the German economy each year https://www.hertie-school.org/en/gesundheitskompetenz/
- 9. Health literacy in United States Below basic – 14% Basic – 21% Intermediate – 53% Proficient – 12% https://health.gov/communication/literacy/issuebrief/
- 10. What implications? Major 2012 https://www.bmj.com/content/345/bmj.e8364.full
- 11. Types of health literacy • Functional – obtain and apply information • Interactive – extract relevant information and apply to changing circumstances • Critical – analyse and gain control Don Nutbeam, 2000 https://academic.oup.com/heapro/article/15/3/259/551108
- 12. Application of health literacy • Functional – read appointment letters, understand time, follow simple medicines guidance • Interactive - ability to balance content from different sources and to make decisions • Critical – ability to read critically and to challenge sources
- 13. Levels change “I’m a professor, yet the first thing I did was I put ‘breast cancer’ into Google… because you’re frightened.” Trisha Greenhalgh
- 14. Health literacy moment Health Literacy Moment Empowered Enabled Encouraged Skills Situation Setting Ruth Carlyle 2019
- 16. What does it feel like? Low health literacy
- 17. What does this mean?
- 18. Code
- 19. It was just… B E A D E D
- 20. How did it make you feel?
- 21. Implications • Misunderstanding • Poor decisions • Exacerbated inequalities • Inappropriate use of medication • Ineffective access to health services • Poor health outcomes
- 22. How can we help? Addressing health literacy
- 23. “How to” guide Definitions General communication Verbal communication Written communication: • Style • Design • Print • Pictures, photographs and symbols https://www.hee.nhs.uk/our-work/health-literacy
- 24. Spoken communication: Teach Back 1. Communicator takes responsibility 2. Tell me 3. Re-explain as needed 4. Continue until both happy with understanding
- 25. Spoken communication: Chunk & Check
- 26. Written communication • Keep sentences short, using lists where appropriate • Use active verbs • Avoid writing in the third person • Use words that are appropriate for the reader
- 27. Aligning skills Critical Interactive Functional • Appraisal • Assessing bias • Comprehension • Awareness • Info literacy • Digital literacy
- 28. Health literacy friendly services 1/2 Element Evidence Written communication Guidance to staff on language used User testing Policy Spoken communication Guidance to staff Staff use of tools, such as teach back, to check communication Help offered as a matter of routine Stock Patient information materials either held in range of formats or guidance on accessing range of formats
- 29. Health literacy friendly services 2/2 Element Evidence Signage Regular review of external signage to ensure service can be located Testing with library users of signage within service Training Training on health literacy awareness Training appropriate to roles on health literacy skills Policy Policies for the services reflect the health literacy needs of staff and service users [Health literacy policy for the service]
- 30. Activity now: health literacy awareness
- 31. Next steps: Knowledge for Healthcare • First 5 years of 15 year framework • Consulting on next 5 years • Patient information and health literacy part of the developments https://kfh.libraryservices.nhs.uk/
- 32. The future: e-health literacy • Future depends on digital literacy and e- health literacy • Information literacy an enabler of that future https://www.hee.nhs.uk/our-work/topol-review
- 33. Ruth Carlyle @RuthCarlyle Ruth.Carlyle@hee.nhs.uk What questions or comments do you have?
Hinweis der Redaktion
- Personal introduction As professionals with an interest in information literacy, you will already know that information literacy, including digital literacy, enables people to access information and to assess information for bias. With health literacy, these skills move beyond the “nice to have” But make choices that have implications for our health, even our life and death choices - so, what are the issues in health and care?
- The health workforce is coming under increasing pressure with: Population increasing by 7% from 2012 to 2020 (to 68 million) Increased cost with multi-morbidities (up 30% between 2012 and 2020) Ageing population, with multi-morbidities Hence: Pressure placed on the workforce (both paid workforce and informal carers) In 2017, there were 2.5 million people living with and beyond cancer; by 2030, there will be 4 million. NHS care model cannot keep pace with this degree of change. Ensuring access to current evidence is vital in an over-stretched health system. - This provides an opportunity for health information
- As the health and care workforce comes under more pressure: Greater expectation of self care / prevention to keep well; People living longer Changing patient/professional relations – more shared decision making. But this depends on understanding information that is provided [To signage & Classics question]
- Why is it an issue? Stand sit re Classics degree Neurology Radiology Gynaecology This instance also includes names, e.g. Cedar Ward Marjory Warren Ward James MacKenzie Ward We may not even be able to find where an appointment is taking place, never mind participate fully [- to definition health literacy]
- What is it? The personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health 2015 World Health Organization adopted definition provides both the personal and system dimensions To scale of issue - literacy
- National % of adult working age population: % able to fully understand and use literacy element of health materials: 57% % unable to fully understand and use information: 43% To scale of issue - numeracy
- National % of adult working age population: % able to fully understand and use literacy and numeracy element of health materials: 39%; % unable to fully understand and use information: 61% Not just in England – link to Germany
- A different assessment model from that used by Gill Rowlands for England, but still shows issue The linked report from Germany is in English - Also an issue outside Europe [to US]
- These are data from 2003, again on a different model, but also show significant scale of issue. Particular issue in States where people need to have financial literacy as part of their health literacy. [-What implications?]
- This includes numbers, words and a chart Early reports on Gill Rowlands’ work (2012 in BMJ – linked) showed over half of the population cannot read this correctly. What does this mean for self-management or care? Health literacy is dependent on literacy and numeracy, but has its own characteristics - [types of health literacy]
- The three “levels” or “types” of health literacy were proposed by Don Nutbeam in 2000 He suggests that they are cumulative, as an individual would need to have both functional and interactive health literacy skills in order to have full critical skills - What do these types/levels of health literacy look like in practice?
- Broadly, the skills we have as library and knowledge specialists map most closely to the Functional and Critical aspects of health literacy, but we can also ensure that clinical colleagues and trainees with whom we are in contact are able to use tools that help - [what does this mean if diagnosed with a significant health condition?]
- At diagnosis, or at a point of shock, health literacy goes down [- my reflection]
- I suggest that each health literacy moment is a combination of: Skills an individual holds; Situation – confidence may be knocked by the shock of a diagnosis; Setting – the signage, resources, institution in which you find yourself. With the right Skills and Situation – may be empowered With the right Skills and Setting – may be enabled With the right Setting and Situation – may be encouraged Personal reflections [ - link to personal story]
- My personal experience
- I am about to give you a test I am going to give you 30 seconds to work out a code No consultation When finished, fold your arms
- Test style Count down, talking over the process
- Not equitable, as some people will read music Even when people read music, a female singer may only usually use the treble clef I was also talking over you, just as health professionals sometimes talk over a patient who is trying to fill out a form [-link – what did it mean?]
- Happy – pleased with yourself Disengaged Unhappy Angry [- what are the implications?]
- Misunderstanding Poor decisions Exacerbated inequalities Inappropriate use of medication Ineffective access to health services Poor health outcomes [not a good scenario – but the good news is that we can help]
- Range of resources: Business case Case studies Training materials “How to” guide [link – teach back]
- With teach back, the communicator takes responsibility for whether information is understood. Rather than, “did you understand?”, “just to check whether I explained this correctly, could you tell me…?” or “What are you planning to do (e.g. specifically when taking a tablet) or “What will you tell your family?” [-often linked to chunk and check]
- A small amount of information, then checking understanding [- not just issues with spoken communication – link written information]
- Summary of key points: Keep sentences short, using lists where appropriate Use active verbs (e.g. take two, not two to be taken) Avoid writing in the third person Use words that are appropriate for the reader Nothing beats user testing [skills we have as specialists already align]
- As librarians and knowledge specialists, we provide support to Functional health literacy through fundamental information literacy and digital literacy support. Interactive skills can be increased through our awareness of “teach back” and “chuck & check” enabling people to use the skills – but also increasing awareness and helping people with comprehension skills Critical health literacy draws on teaching appraisal and higher level assessment of bias [- what can we do to make sure our services are health literacy friendly?]
- Written communication Spoken communication Stock
- Signage Training Policy [- these are points with all services – what about activity in health specifically]
- So, what are we doing in NHS library and knowledge services? We are working to ensure that our own services are health literacy friendly, but also to raise awareness of health and care workforce. Image: Hannah Beckitt, Leicester [- what about strategic direction?]
- What about the future for NHS library and knowledge services? Health literacy will be a part of our role
- Topol review – digital skills needed by the clinical workforce Also by the public You are a part of ensuring the information literacy skills on which that future depends