Making it easier: a health literacy action plan 2017-2025

Action area 3

Shifting the culture by developing more health literacy responsive organisations and communities

Headlines from this section

• We will support the drive to a culture of shared decision-making.
• We will promote approaches that help organisations to be responsive to health literacy needs.
• We will work to embed health literacy concepts within school age education.

Shared decision-making
Health literacy has a vital role in supporting Realistic Medicine’s culture change work towards shared decision-making. Supported shared decision-making has emerged as one of the key areas of focus in the feedback on Realistic Medicine and Realising Realistic Medicine. Wherever possible, we need to enhance people’s ability to be in the driving seat of their own health and care through improving their health literacy. We need to support health organisations to understand health literacy diversity in communities and then be responsive to the community’s needs.

Shared decision-making is not a one-way transmission of information about options and risks from the professional to their patient. It is a two-way relational process of helping people to reflect on, and express, their preferences based on their circumstances, expectations, beliefs, and values.

There is useful learning to draw upon from the MAGIC Programme ^[52] . It found that shared decision-making is not confined to one patient and one clinician during one consultation. The process needs embedded across healthcare teams, and between people and their communities, all of whom will influence the process, especially for people living with long-term conditions.

We will examine aspects of Realistic Medicine including shared decision-making through an Our Voice citizens’ jury. It is likely that some of the major findings from this process will fall under the remit of health literacy so this action plan will provide a place to address them.

Scotland’s updated health and social care standards ^[53] were published in July 2017. They set out what everyone experiencing care should expect, and are common across all of health and care.

One of the standards is that:

• I am supported to make informed lifestyle choices affecting my health and wellbeing, and I am helped to use relevant screening and healthcare services.

This means that everyone involved in the delivery of health and social care services needs to reflect on how they can make this a reality for everyone they work with.

‘Health literacy by design’
We will explore health literacy development approaches that use active community engagement and co-design, such as Deakin University’s Ophelia ^[54] (OPtimising HEalth LIteracy and Access) approach to health literacy. Proactive health literacy-informed co-design will stop the creation of barriers that we’ve been working to remove. Using the local wisdom from the community, we need to work together to develop practitioners and design services that are responsive to people’s health literacy needs from the outset. There is useful learning to draw upon from projects funded by the Self Management Fund for Scotland.

We need to understand the landscape of service change across the health and social care sector in Scotland to develop specific actions and key points to influence system thinking. Of particular relevance is work being progressed under the Our Voice banner.

Creating health literate organisations and communities
At its core, the NHS Tayside’s work under Making it Easy was about creating a focus on improved health literacy within one locality from which we could then spread and share the learning to many. Through this work we now have more confidence in what a health literate organisation looks like. Approaches such as the Ten attributes of a health literate healthcare organisation ^[55] and the work from Deakin University on the Ten Focus Areas for Health Literacy summarise this well.

Belfast Healthy Cities work

Belfast Healthy Cities ^[56] , established in 1988, was among the initial 15 cities to be formally designated as World Health Organization ( WHO) Healthy Cities.

At the time, it introduced an entirely new approach to addressing health inequalities. Its appeal was its focus on health being the responsibility of all sectors, which was considered key to addressing the social determinants of health and inequalities in health.

Belfast Healthy Cities has had significant influence on policy and action in working with other sectors and departments in the areas of health, inequities and wellbeing. It has provided strong evidence and research on how the health of a city can be improved.

With a small, but very effective team, their work together with city stakeholders over the past decades has had far reaching influence on the shaping of health and wellbeing strategy in Belfast and beyond.

Emerging work from Deakin looks at an Organisational Health Literacy Assessment Tool ^[57] . This tool can help organisations find their priority areas for action on health literacy, building on their strengths and assets, while targeting their weaknesses. We will promote this approach to spread our learning to organisations across all sectors.

Likewise, we need to support the building of health literate communities. People should be supported to tap into local networks and resources. Knowledge and skills exist across communities, such as within library services, and offer opportunities to improve health literacy. We need to consider the needs of people who are isolated or have few social connections, by linking with emerging national work to tackle social isolation and loneliness. In addition, the case for asylum seeker and refugee populations is covered by our New Scots ^[58] work.

There are strong examples that we can draw upon of how services have worked to make it easier for people to understand how health and care works in Scotland because they come from different cultures and countries. Explaining basic concepts, often for those with language barriers, such as that the NHS is free to access or how to register with a GP or dentist, can be vital in welcoming people into our communities. New Scots offers a fresh chance to work with migrant populations to improve how their access needs inform our overall approach.

Ideas to improve how people think about their health and wellbeing need to be embedded at as early a stage as possible in their lives. We will consider approaches that have been tried with some success in other countries which have begun to show that young people can be better supported to interpret health information ^[59] . We will work with the Royal Pharmaceutical Society to further their ambition to embed health literacy within school age education.

How we evaluate impact
Through this phase of work, the emphasis will be on improving the quality of people’s experience with the health and care system. Simple measures such as confidence scales can show improvements in awareness, understanding and confidence, all of which are key markers of improved health literacy responsiveness.

The Organisational Health Literacy Assessment Tool provides a clear way of tracking strengths, weaknesses and systematically building health literacy into quality improvement processes across a wide range of organisations.

Stories are a key form of evidence for improved health literacy impact. We will use tools such as Care Opinion ^[60] to capture experiences, innovation and feedback.