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Gill Rowlands Heath Literacy - Making it Everybody's Business

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Heath Literacy - Making it Everybody's Business
Seminar June 25th 2015

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Gill Rowlands Heath Literacy - Making it Everybody's Business

  1. 1. Working together Update on the Royal College of General Practitioners and NHS England report and action plan Health literacy – Making it everybody’s business Thursday 25th June 2015 Gill Rowlands, Professor, University of Newcastle and Aarhus University June 2015 1
  2. 2. 2 http://www.rcgp.org.uk/news/2014/june/~/media/Files/Policy/RCGP-Health-Literacy-2014.ashx Gill Rowlands Joanne Protheroe Hannah Price Bob Gann Imran Rafi
  3. 3. This presentation • What did we discuss at the workshop in July 2013? – What is health literacy? – Is health literacy important? – What challenges does health literacy bring to patients, health care staff, managers and commissioners? – What can be done to make things better? – A Call for Action • Progress so far • Next steps • Do we need to know anything else about health literacy? 3
  4. 4. What is health literacy 4 “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.” World Health Organization. Health literacy toolkit for low- and middle-income countries. A series of information sheets to empower communities and strengthen health systems. 2015. www.searo.who.int/entity/healthpromotion/documents/hl_tookit/en/
  5. 5. Yes! People with low health literacy are sicker than people with higher health literacy. They: •Die earlier1,2 •Find it more difficult to take their medication as instructed1 •Are more likely to have one or more long-term conditions (LTCs)3 •LTCs more likely to be limiting3 •Are less likely to engage with disease prevention e.g. cancer screening, immunisation1 5 1. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: An updated systematic review. Rockville, MD: Agency for Healthcare Research and Quality., 2011 Contract No.: 11-E006. 2. HLS-EU Consortium: Comparative report of health literacy in eight EU member states. The European Health Literacy Survey (HLS-EU). 2012 3. Bostock S, Steptoe A. Association between low functional health literacy and mortality in older adults: longitudinal cohort study. British Medical Journal. 2012;344:e1602. Is health literacy important?
  6. 6. Yes! People with low health literacy are less healthy than people with higher health literacy. They have: •More unhealthy behaviours; alcohol, poor diet/obesity, smoking2,3 •Fewer healthy behaviours; good diet/normal weight2,3 •Lower levels of self-rated health1,2 •Lower response to public healthy living campaigns3 6 1. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: An updated systematic review. Rockville, MD: Agency for Healthcare Research and Quality., 2011 Contract No.: 11-E006. 2. HLS-EU Consortium: Comparative report of health literacy in eight EU member states. The European Health Literacy Survey (HLS-EU). 2012 3. Buck D, Frosini F. Clustering of unhealthy behaviours over time. Implications for policy and practice. . London: King's Fund, Aug 2012. Is health literacy important?
  7. 7. Is health literacy a common problem? Yes! 7 % of the adult working age population unable to fully read, understand, and act on health information in common circulation. National average 61% Rowlands, G., Protheroe, J., Richardson, M., Seed, P., Winkley, J., and Rudd, R. (2015). The health information gap: the mismatch between population health literacy and the complexity of health information; an observational study. British Journal of General Practice 65 e379 -e386.
  8. 8. Is low health literacy associated with other social determinants of health? Yes! Male (literacy) Female (numeracy) Male (literacy) Female (numeracy) Aged 45+Aged 45+ BMEBME Born outside of the UK Born outside of the UK English not first language English not first language Below expected by age 16 Below expected by age 16 UnemployedUnemployed Lowest job grade Lowest job grade Income less than £10,000 Income less than £10,000 Not a home owner Not a home owner Top 5 most deprived areas Top 5 most deprived areas Not statistically significant when considered together Rowlands G, Protheroe J, Richardson M, et al. The health information gap: the mismatch between population health literacy and the complexity of health information; an observational study. BJGP Accepted for publication. 2015.
  9. 9. What challenges does health literacy bring? • Patients: – coping with a complex system that is not tailored to their health literacy needs • Health care professionals: – Lack of knowledge about the importance and impact of low health literacy – Lack of skills in tailoring communication and services to patients’ health literacy needs • Managers: – Developing ‘health literate’ systems and services tailored to patient need – Up-skilling health care staff • Commissioners – Ensuring people with low health literacy have a voice and can influence the design of services to meet their needs – Using the power of commissioning to develop health literate health services 9
  10. 10. Can anything be done to help? Yes Improving the system •Improving how information is written improves understanding of information1 •Use of pictograms improves understanding of risk2 •Current international service development project involving several UK sites: the Ophelia project3 is exploring how health care organisations’ understanding of patients’ health literacy needs can be used to improve the service 10 1. Scott, T.L., et al., Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care, 2002. 40(5): p. 395-404. 2. Garcia-Retamero R, Galesic M. Communicating treatment risk reduction to people with low numeracy skills: a cross-cultural comparison. Am J Public Health. 2009;99(12):2196-202 3. http://www.deakin.edu.au/health/research/phi/OPHELIA.php
  11. 11. Can anything be done to help? Yes Building citizens health literacy skills •Improves knowledge and skills1 •Improves lifestyle (diet and exercise)1 •Improves mental health1,2 •Improves Diabetes self-management3 Building health professionals’ health literacy awareness and skills Current project: Awareness raising and training of health care staff: Community Health and Learning Foundation 11 1. Evaluation of the second phase of the Skilled for Health Programme. London: The Tavistock Institute and Shared Intelligence, 2009. 2. Weiss BD, Francis L, Senf JH, Heist K. Literacy education as treatment for depression in patients with limited literacy and depression: a randomized controlled trial. J Gen Intern Med 2006;21:823–8 3. Rothman RL, DeWalt DA, Malone R, et al. Influence of patient literacy on the effectiveness of a primary care-based diabetes disease management program. Journal of the American Medical Association. 2004;292(14):1711-6.
  12. 12. What are some solutions: the joint RCGP and NHS England call for action 1. To work with the Health Literacy Group UK to take the ‘Call for Action’ forward. 2. To improve GP training. 3. To develop recommendations for Clinical Commissioning Groups (CCGs) to consider health literacy approaches by NHS service providers when commissioning services. 4. To develop pilot sites where CCGs can commission health literacy training for patients from adult learning providers, with assessment of the impact of these pilots on patient skills, patient satisfaction with NHS services and their use of NHS services. 5. To ensure that those aspects of the Digital Inclusion Strategy relevant to general practice are highlighted to GPs. 6. To work with the Information Standard to develop a health literacy guide to be circulated to all NHS Trusts. 12
  13. 13. Progress so far • NHS England is committed to working with partners to support progress around health literacy – it is an agenda that cannot be addressed unilaterally • This needs to be undertaken in parallel with other activities to improve and streamline health information and communication systems • The Information Standard has been brought ‘in house’ to improve it’s engagement and effectiveness (especially for NHS Trusts) and streamline costs • NHS England has pulled together a roundtable involving Health Literacy Group UK, Royal College of GPs, ALBs, and a range of other organisations to identify next steps and ensure a co-ordinated approach 13
  14. 14. Next steps • Develop a wider programme of work which addresses both the quality and accessibility of health information alongside ensuring people have the skills to be able to understand and apply it 14
  15. 15. • Work with partners to develop a plan to support progress with health literacy which might include: – Using the Information Standard to improve the ‘health literacy’ of health information – Provide implementation support for the Accessible Information Standard as a way of supporting people with access and communication needs – Work with the NHS England digital inclusion strategy to widen digital skills and participation for health – Establish the best way to use the commissioning system to support action on health literacy, both in public engagement and in the services which are commissioned – Work with the partners to improve the health literacy skills of health professionals 15
  16. 16. Conclusions • Health literacy affects a significant proportion of people (6 out of 10 in England) • It results in less health and more illness, but much can be done to improve both health literacy skills and the approaches of the health and education sectors • Progress is being made against the objectives in the ‘Call for Action’ but more needs to be done 16
  17. 17. Points for discussion • The call for action: what needs prioritising and why? • Do we need to know anything more? What about: – The cost of health literacy to patients, the public and the NHS? – What are the cost / benefits of lifelong learning interventions – both in health but also in communities and wider society – Health literacy and wider skills, employability and productiveness? 17
  18. 18. Working together Update on the Royal College of General Practitioners and NHS England report and action plan Health literacy – Making it everybody’s business Thursday 25th June 2015 Gill Rowlands, Professor, University of Newcastle and Aarhus University June 2015 18
  19. 19. Additional slides if needed 19
  20. 20. National Qualifications level: Literacy level 1 / Numeracy level 1 Key Stage Skill Equivalent Ages: Literacy 11-14 years, Numeracy 11-14 years Number (%) English adults 16-65 yrs. UNABLE to understand and use this: 21 million people (61%) Example: Bowel Cancer Screening Kit
  21. 21. NQF level Key stage equivalent At this LITERACY level an adult understands Entry level 1 5-7 years Short texts with repeated language patterns on familiar topics Entry level 2 7-9 years Short straightforward texts on familiar topics and from familiar sources Entry level 3 9-11 years Short straightforward texts on familiar topics accurately and independently Information from everyday sources Level 1 11-14 years Short straightforward texts of varying length on a variety of topics accurately and Independently Level 2 14-16 years A range of texts of varying complexity accurately and independently Information of varying length and detail Material levelMaterial level Population level Skills Qualification Framework Literacy
  22. 22. NQF level Key stage equivalent At this NUMERACY level an adult understands Entry level 1 5-7 years Numbers and symbols in a simple format Entry level 2 7-9 years Numbers, symbols, simple diagrams and charts in a simple format Entry level 3 9-11 years Numbers, symbols, diagrams and charts used for different purposes and in different ways Level 1 11-14 years Straightforward mathematical information, can independently select relevant information Level 2 14-16 years Mathematical information used for different purposes, can independently select and compare relevant information from a variety of sources Material levelMaterial level Population level Skills Qualification Framework Numeracy
  23. 23. Is low health literacy a common problem? Yes The situation in Europe. 23 From the HLS-EU final report. SLIDE COURTESY OF Prof. Jürgen M. Pelikan Ludwig Boltzmann Institute Health Promotion Research, WHO-CC for Health Promotion in Hospitals and Health Care, Vienna/ Austria.

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