healthliteracy - Dr. Olusegun Adeniyi 20240612.pptx

Demonstrator of public health and community medicine

1. HEALTH LITERACY By Dr. Adeniyi Olusegun PhD, FAPH Deputy Project Director/Clinical Lead World Bank Funded Project, Nigeria Demonstrator of Public health and community medicine

2. What is literacy? Literacy can be defined as a person's ability to read, write, speak, and compute and solve problems at levels necessary to: Function on the job and in society Achieve one's goals Develop one's knowledge and potential The term “illiteracy” means being unable to read or write. A person who has limited or low literacy skills is not illiterate.

3. Examples of literacy: Financial literacy. Media literacy. IT literacy. Political literacy. Health literacy. Computer literacy.

4. What is health literacy? Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health Literacy has been defined by WHO as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Health literacy is dependent on individual and systemic factors: Communication skills of lay persons and professionals Professional knowledge of health topics Culture Demands of the healthcare and public health systems Demands of the situation/context

5. Domains of health literacy Health literacy comprises two main domains: 1- Functional health literacy (FHL) : Which is concerned about individuals' ability to read health-related information 2- Comprehensive health literacy (CHL) : Which represents individuals' ability to obtain, understand, appraise, and apply health-related information to promote health or prevent diseases.

6. Health literacy affects people's ability to: Navigate the healthcare system, including filling out complex forms and locating providers and services Share personal information, such as health history, with providers Engage in self-care and chronic disease management Understand mathematical concepts such as probability and risk Health literacy includes numeracy skills. For example, calculating cholesterol and blood sugar levels, measuring medications, and understanding nutrition labels require math skills. Choosing between health plans or comparing prescription drug coverage requires calculating premiums, copays, and deductibles.

7. In addition to basic literacy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease. Without this knowledge, they may not understand the relationship between life style factors such as diet and exercise and various health outcomes. Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.

8. Who is at risk? Populations most likely to experience low health literacy are older adults racial and ethnic minorities people with less than a high school degree or Graduate Equivalency Degree certificate people with low-income levels non-native speakers of English people with compromised health status. Education, language, culture, access to resources, and age are all factors that affect a person's health literacy skills.

9. Who is responsible for improving health literacy? The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems. We must work together to ensure that health information and services can be understood and used by all Nigerians We must engage in skill-building with healthcare consumers and health professionals. Adult educators can be productive partners in reaching adults with limited literacy skills.

10. Health Literacy and Health Outcomes 1- Use of preventive services Persons with limited health literacy skills are more likely to skip important preventive measures such as mammograms, Pap smears, and flu shots. Compared to those with adequate health literacy skills, studies have shown that patients with limited health literacy skills enter the healthcare system when they are sicker. 2- Knowledge about medical conditions and treatment Persons with limited health literacy skills are more likely to have chronic conditions and are less able to manage them effectively. Studies have found that patients with high blood pressure, diabetes, asthma, or HIV/AIDS who have limited health literacy skills have less knowledge of their illness and its management.

11. 3- Rates of hospitalization Limited health literacy skills are associated with an increase in preventable hospital visits and admissions. Studies have demonstrated a higher rate of hospitalization and use of emergency services among patients with limited literacy skills. 4- Health status Studies demonstrate that persons with limited health literacy skills are significantly more likely than persons with adequate health literacy skills to report their health as poor. 5- Healthcare costs Persons with limited health literacy skills make greater use of services designed to treat complications of disease and less use of services designed to prevent complications. Studies demonstrate a higher rate of hospitalization and use of emergency services among patients with limited health literacy skills. This higher use is associated with higher healthcare costs.

12. 6- Stigma and shame Low health literacy may also have negative psychological effects. One study found that those with limited health literacy skills reported a sense of shame about their skill level. As a result, they may hide reading or vocabulary difficulties to maintain their dignity

13. Health literacy – a key determinant of health Literacy is a stronger predictor of an individual’s health status than income, employment status, education level and racial or ethnic group. High literacy rates in population groups benefits societies . Literate individuals participate more actively in economic prosperity, have higher earnings and employment, are more educated and informed and contribute more to community activities and enjoy better health and well-being. 2. Limited health literacy (as measured by reading skills) significantly affects health . Limited health literacy is associated with less participation in health-promoting and disease detection activities, riskier health choices (such as higher smoking rates), more work accidents, diminished management of chronic diseases (such as diabetes, HIV infection and asthma), poor adherence to medication, increased hospitalization and re-hospitalization

14. 3. Limited health literacy follows a social gradient and can further reinforce existing inequalities . People with limited health literacy most often have lower levels of education, are older adults, are migrants and depend on various forms of public transfer payments. How limited general literacy affects people’s health cannot always be clearly separated from how Limited health literacy affects people’s health. This is an ongoing debate. The European Health Literacy Survey confirms a social gradient for education, by showing that health literacy is significantly higher among people with more education in all participating countries, but this differs somewhat between countries

15. 4. Building personal health literacy skills and abilities is a lifelong process . No one is ever fully health literate. Everyone at some point needs help in understanding or acting on important health information or navigating a complex system. Even highly educated individuals may find health systems too complicated to understand, especially when a health condition makes them more vulnerable. 5. Capacity and competence related to health literacy vary according to context, culture and setting . They depend on individual and system factors. These factors include communication skills, knowledge of health topics, culture and the specific characteristics of the health care, public health and other relevant systems and settings where people obtain and use health information. When these services or systems, for example, require knowledge or a language level that is too high for the user, health suffers.

16. 6. Limited health literacy is associated with high health system costs . Weak health literacy is expected to drain the resources of health systems in European welfare states that provide nearly universal access.

17. Levels of health literacy Basic/functional literacy — sufficient basic skills in reading and writing to be able to function effectively in everyday situations. This means being able to read health related pamphlets, or read the label on a pill bottle.   2. Communicative/interactive literacy — More advanced cognitive and literacy skills which, together with social skills, can be used to actively participate in everyday activities, to extract information and derive meaning from different forms of communication, and to apply new information to changing circumstances. At this level a person can, for instance, read and interpret health information from the internet and discuss this with a physician when negotiating treatment.  

18. 3. Critical literacy — more advanced cognitive skills which, together with social skills, can be applied to critically analyze information, and to use this information to exert greater control over life event situations. A person with critical literacy can effectively self manage, ask for help when appropriate and make informed decision

19. Limited health literacy: an underestimated problem and equity challenge Nearly half of all Europeans have inadequate and problematic health literacy skills Limited HL has been established as a growing problem affecting both individuals and the general population. Low literacy levels are common . Many children, adolescents and adults have limited literacy skills, even in economically advanced countries with strong education systems 2. Limited health literacy is very common . Like general literacy, health literacy can be measured at the individual, organizational, community and population levels. The European Health Literacy Survey revealed that 12% of all respondents have inadequate general health literacy and 35% have problematic health literacy. Limited health literacy in Europe is thus not just a problem of a minority of the population

20. 3. Countries vary greatly . Limited (inadequate plus problematic) health literacy varied between 29% for the Netherlands and 62% for Bulgaria In Egypt, It was found that 81% of the participants had limited comprehensive health literacy (CHL; 34.3% inadequate and 46.7% problematic), while only 18.9% had sufficient CHL Regarding functional health literacy (FHL), it was found that 84% had limited FHL (50.6% inadequate and 33.4% problematic), while only 16.1% had sufficient FHL. 4. Certain groups are more vulnerable . Specific vulnerable groups have much higher proportions of limited health literacy than the general population in Europe, including lower social status (low self-assessed social status, low level of education, low income, and problems in paying bills), with worse health status (measured by self-perceived health, long-term illness, and limitations in activities because of health problems) or relative old age. Again, the diversity in Europe is very pronounced

21. Models of health literacy: Functional health literacy: refers to basic skills in reading and writing and capacity to apply these skills in everyday concepts; Interactive health literacy: refers to more advanced cognitive and literacy skills, greater ability to obtain relevant information, derive meaning and apply new information to changing circumstances; Critical health literacy: refers to the most advanced cognitive and literacy skills, critical analysis of information, and ability to use information to respond, adapt and control life events.

22. Benefits of Health Literacy: To individuals in general: Find information and services. Process the meaning and usefulness of the information and services. Understand the choices, consequences and context of the information and services. Communicate their needs and preferences and respond to information and services. Decide which information and services match their needs and preferences so they can act.

23. To health care givers: Help people find information and services. Communicate about health and healthcare. Process what people are explicitly and implicitly asking for. Understand how to provide useful information and services. Decide which information and services work best for different situations and people so they can act.

24. Assessment of low health literacy: Informal patient assessment: Frequently miss appointments; Fail to complete registration forms; Be unable to name medications or explain their purpose or dosing; Identify pills by looking at them, not reading label; Be unable to give coherent, sequential medical history; Show lack of follow-through on tests or referrals; and/or Repeatedly use statements such as "I forgot my reading glasses," "I'll read through this when I get home," or "I’m too tired to read,” When asked to discuss written material.

25. Formal Patient Assessments: There are 3 common tools used by organizations to identify individuals with low health literacy by assessing their word recognition and reading comprehension: REALM (Rapid Assessment of Adult Literacy in Medicine). TOFHLA (Test of Functional Health Literacy in Adults). NVS (Newest Vital Sign).

26. Rapid Estimate of Adult Literacy in Medicine: REALM

27. Test of Functional Health Literacy in Adults : TOFHLA Reading comprehension (50 items) Numerical ability (17 items) Scoring into: inadequate, marginal, adequate.

28. Newest vital sign (NVS) READ TO SUBJECT: This information is on the back of a container of a pin of ice cream. QUESTIONS 1. If you eat the entire container, how many calories will you eat? Answer: 1000

29. Factors affecting health literacy: Communication skills of lay persons and professionals: Communication skills include literacy skills (e.g., reading, writing, and numeracy), oral communication skills, and comprehension. Communication skills are context specific. Lay and professional knowledge of health topics: People with limited or inaccurate knowledge about the body and the causes of disease may not: Understand the relationship between lifestyle factors (such as diet and exercise) and health outcomes Recognize when they need to seek care Health information can overwhelm people with advanced literacy skills.

30. Culture affects: How people communicate and understand health information. How people think and feel about their health. When and from whom people seek care. How people respond to recommendations for lifestyle change and treatment. Demands of the healthcare and public health systems: Individuals need to read, understand, and complete many kinds of forms in order to receive treatment and payment reimbursement. Individuals need to know about the various types of health professionals and services as well as how to access care .

31. Demands of the situation/context: Health contexts are unusual compared to other contexts because of an underlying stress or fear factor. Healthcare contexts may involve unique conditions such as physical or mental impairment due to illness. Health situations are often new, unfamiliar, and intimidating. Relative ICT literacy: Digitalization of health related resources makes it mandatory to have relative internet literacy and access. Recent advances in telemedicine modalities require the public to have necessary functional knowledge of the technological developments. Mobile health and the innovative apps are in the core of today’s health service provision inevitable.

32. How to improve health literacy: The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems. CDC: has created a plan to improve how we create and share health information and provide public health services to different audiences. This plan is organized in 3 goals.

33. CDC’s Health Literacy Goals: Develop and disseminate health and safety information that is accurate, accessible, and actionable. Integrate clear communication and health literacy in public health planning, funding, policy development, research, and evaluation. Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in educational settings from childcare through university levels.

34. How to improve health literacy:

35. How to improve health literacy: 1. Improve the Usability of Health Information: Health information should be (The Three A’s): Accurate:  Health literacy practices make sure information is presented accurately and in ways that people can understand. Accessible:  Just because you create health information doesn’t mean people see it or can use it. Where and how you present your information affects its accessibility. Actionable: make sure you provide actionable information so the people you want to reach CAN do something with the information provided.

36. Acknowledge Cultural Differences and Practice Respect: Cultural competence is the ability of health organizations and practitioners to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of diverse populations and to apply that knowledge to produce a positive health outcome. Competency includes communicating in a manner that is linguistically and culturally appropriate. On the Internet: Plain language (Organizing information so most important points come first - Breaking complex information into understandable chunks - Using simple language and defining technical terms - Using active voice - Using lists and tables to make complex material easier to understand – using teach back method to make sure the message is delivered correctly).

37. 2. Improve the Usability of Health Services: Improve the usability of health forms and instructions: Healthcare and public health settings rely heavily on forms and printed instructions. Revise forms to ensure clarity and simplicity. Test forms with intended users and revise as needed. Provide forms in multiple languages. Offer assistance with completing forms and scheduling follow up care. Improve the accessibility of the physical environment: Settings with lots of signs and postings have a high literacy demand. Include universal symbols and clear signage in multiple languages. Promote easy flow through healthcare facilities. Create a respectful and shame-free environment. Establish a patient navigator program: Patient navigators are health professionals or community health workers who help patients: Evaluate their treatment options Obtain referrals Find clinical trials Apply for financial assistance

38. 3-Build Knowledge to Improve Decision Making: Improve access to accurate and appropriate health information: Create new mechanisms for sharing and distributing understandable health education materials: Identify new methods for information dissemination: Form partnerships with civic and faith-based organizations trusted in the community. Work with the media to increase awareness of health literacy issues. Work with providers to ensure that the health information they share is accurate, current, and reliable.

39. Facilitate healthy decision making: Use short documents that present “bottom-line” information, step-by-step instructions, and visual cues that highlight the most important information: People process and use a limited amount of information when making a decision. Align health information and recommendations with access to services, resources, and support. Partner with educators to improve health curricula: Incorporate health-related tasks, materials, and examples into lesson plans. Design and disseminate health information to support existing state standards. Speak to students or help organize health-related field trips for local schools.

40. 4-Advocate for Health Literacy Improvement: Make the case for improving health literacy: Identify specific programs and projects affected by limited health literacy. Target key opinion leaders with health literacy information: Explain how health literacy improvement relates to your mission, goals, and strategic plan. Circulate relevant research and reports on health literacy to colleagues. Post and share health literacy resources. Incorporate health literacy in mission and planning: Include goals and objectives specifically related to health literacy improvement in: Strategic plans Program plans Educational initiatives Goals can be broad (e.g., Achieving Healthy People) or specific to the mission of the office/program.