Making it Easy

Some facts that should get your attention

George Bernard-Shaw
"The single biggest problem with communication is the illusion that it's taken place"

Is health literacy really such a big issue?

The problem of poor health literacy affects a significant portion of the population.

• The proportion of the population with inadequate health literacy in a sample of eight European countries is 47% - almost half the population^[1].
• 43% of English working-age adults will struggle to understand instructions to calculate a childhood paracetamol dose^[2].
• The cost to the US economy, because of inadequate health literacy, is estimated to be in the region of $106-$236 billion per year^[3].
• 26.7% of people in Scotland have occasional difficulties with day-to-day reading and numeracy. 3.6% will have severe constraints^[4].

How does poor health literacy affect people's health?

• Those of us with lower levels of health literacy:^{[5] [6]}
  • are generally 1.5 to 3 times more likely to experience a given poor outcome
  • have poorer health status and self-reported health
  • wait until we're sicker before we go to the doctor
  • find it harder to access services appropriate to our needs
  • find it harder to understand labelling and take medication as directed
  • are less able to communicate with healthcare professionals and take part in decisions
  • are less likely to engage with health promotional activities, such as influenza vaccination and breast screening
  • are at increased risk of developing multiple health problems
  • have higher rates of avoidable and emergency admissions
  • have higher risks of hospitalisation and longer in-patient stays
  • have difficulty managing our own health and wellbeing, that of our children, and of anyone else we care for
  • have greater difficulty looking after ourselves when we have long-term conditions

Why do healthcare professionals underestimate our health literacy needs?

Healthcare professionals often underestimate our health literacy needs. This is because these needs often remain hidden and some of us actively hide them.^[7] This may be because we are too ashamed, or too polite to reveal to others that we have not understood them. While this is particularly common in those who have difficulty reading, writing or using numbers, it can affect all of us - particularly if we are overwhelmed by anxiety or worry.

Why can it be difficult for clinical and other staff to take account of health literacy needs?

People working in health and social care usually respond well to obvious difficulties. However, when health literacy needs are hidden, clinical and other staff can make false assumptions about what has been heard - and what has been understood. The concepts and language used may seem unfamiliar and strange. To avoid this, clinical and other staff should try and understand us and the difficulties we may face in understanding. Addressing health literacy is a two-way street.

To learn more about Making it Easy please visit www.healthliteracyplace.org.uk

Case study

Margaret is 57 and has struggled with reading and writing all her life. As a child, she was bullied and humiliated about this. Now Margaret feels ashamed and doesn't want anyone to know. She relies heavily on her husband, Tom, to help her with her medicines for several long-term conditions. Tom has some health problems too and had an emergency admission to hospital recently, but fortunately was home after two days. Tom missed a lot of school, and although he reads Margaret the information leaflets and booklets she has been given, he sometimes struggles with difficult words and phrases. When Margaret was recently diagnosed with diabetes she found it very worrying, because she didn't understand what she needed to do. However, when she goes to her appointments, the doctor or nurse asks if she understands what she has been told - she nods and says in a very convincing way that she does. She doesn't want them to think she is stupid.

Why is addressing health literacy important?

Because whenever our health literacy needs are not met, the safety, effectiveness and person-centredness of our care is undermined:

• Ineffective communication undermines our capacity to be in the driving seat of our care, which is the cornerstone of self management, and key to person-centred care.
• When our health literacy needs are met, we are better able to work with our health care professionals to safeguard our own care and live well.

Also addressing health literacy is fundamental to the following:

• The 2020 Vision for Health and Social Care^[9] has a focus on prevention, anticipation and supported self management.
• The Healthcare Quality Strategy for NHSScotland^[8] sets out the ambition to deliver the highest quality health care to the people of Scotland through safe, effective and person-centred care.
• The Patient Rights (Scotland) Act 2011 aims to improve our experience of using health services and to support us to become more involved in our health and health care. It says that the health care we receive must consider our needs, consider what would be of optimum benefit to us, encourage us to take part in decisions about our health and wellbeing, and provide information and support for us to do so, in a way we understand.
• Health professionals are guided by Codes of Conduct to adapt their practices so that they communicate in ways that we can eac h understand. This can be hugely challenging and may require new ways of working and communicating, using a variety of formats, media and technologies.
• Addressing health literacy will help us to reduce health inequalities. This is because those of us with poor health literacy have the highest burden of ill health. Those of us with the lowest health literacy generally have double the rates of poor health outcomes, complications and death, compared with those who have the highest abilities^[10].

Case study

From talking to an adult learner

"I don't know if it was common, but the surgeon would ask me questions and when I couldn't remember or I couldn't answer him, what he did was, he says, 'I'm going to tell you what's going on' and it was all recorded on tape, and he gave us the tape to take home, so I could listen to everything he was saying and go over anything I wasn't sure of. So I was able to write it down…. and ask him."

Case study

"I was on so many different tablets, I would get them mixed up. I didn't want to admit I was struggling but then I got ill and ended up in hospital. When I came out of hospital, the nurse had given me a chart of what and when to take, and she also checked that I had understood it all. It gave me a lot of confidence."