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Health Literacy:
Knowledge for Healthcare and building your skills
Ruth Carlyle, Head of Library and Knowledge Services – East of England and Midlands,
Co-Lead Health Literacy and Patient Information with NHS libraries, Health Education
England
Nov 2020
@NHS_HealthEdEng
@NHS_HealthEdEng #HEELKS @RuthCarlyle
Topics covered
• Health literacy – what it means
• Scale of the issue
• Implications
• How are you using health literacy skills in
your life?
• Do you know your rights as a patient?
• Knowledge for Healthcare approach
• Two techniques
• Tips for signposting to health information
• Where next?
Let’s talk about health information
• Have you ever searched for health information online?
• Decided how many tablets you need to take?
• Thought about whether to share health information
through social media?
• Worked out what you want to ask a health professional?
• Followed the signs to get to the right department in a
hospital?
Health literacy
The ability to access, assess and
use health information to make
health-related decisions
What does it mean day to day?
Need to understand how information is presented
https://fullfact.org/health/mail-guardian-2m/
How many people struggle with reading?
16.4% (or 1 in 6) of adults in
England, and 17.9% (or 1 in 5)
adults in Northern Ireland,
have literacy levels at or below
Level 1 (GCSE grades D-G)
http://www.oecd.org/skills/piaac/
52
35
3538
40
41
44
44
46
National average
43% unable to understand
written health information
Scale of the issue: literacy (16-65 years)
Rowlands et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/26009533
66
55
5455
59
60
60
62
64
National average
61% unable to understand
health information
when numbers included
Scale of the issue: literacy and numeracy (16-65
years)
Rowlands et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/26009533
How much does it vary?
Geodata on local health
literacy
Example of
Cambridgeshire
(percentage adults
unable to follow health
information that includes
both words and numbers)
http://healthliteracy.geodata.uk/
Implications
• Misunderstanding
• Poor decisions
• Exacerbated inequalities
• Inappropriate use of medication
• Ineffective access to health services
• Poor health outcomes
How far are you using health literacy in your own
life? • 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
Don Nutbeam, 2000 https://academic.oup.com/heapro/article/15/3/259/551108
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
Knowledge for Healthcare
• Evidence for whole NHS
workforce, not just learners
• Libraries as business critical
• Informing the design of roles
and services
• Focus on Health Literacy and
Patient Information
https://www.hee.nhs.uk/our-work/library-knowledge-services
Approved
strategy
2021-26
E-learning on Health Literacy awareness
developed with NHS Education for Scotland
15-minute Health Literacy introduction
1-hour Health Literacy awareness introduction,
accredited by Royal Society for Public Health
Health Literacy awareness training
Health Literacy
“train the trainer” training
Ruth Carlyle & Sally James, HEE Midlands, September 2019
Spoken communication: Teach Back
1. Communicator takes
responsibility
2. Tell me
3. Re-explain as needed
4. Continue until both happy
with understanding
Ask 3 Questions
1. What are my options?
2. What are the pros and cons of
each option for me?
3. How do I get support to help me
make the decision that is right
for me?
https://www.pat.nhs.uk/downloads/patient-information-leaflets/other/Ask%203%20Questions%20Leaflet.pdf
E-Learning
• 35-minute programme
• Action plan to include in CPD
file
• https://www.e-
lfh.org.uk/programmes/health-
literacy/
Jointly developed by NHS Education for Scotland
and Health Education England
“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
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
- Is it dated (and less than 3 years old)?
- Does it have a review date (and is it within that review date)?
- Does it say who wrote it?
- Does it give the evidence base?
- Does it say who funded it?
- Were users involved in developing and/or testing it?
Before you signpost to health information
Your right: Accessible Information format
1. Ask
2. Record
3. Flag
4. Share
5. Provide
Accessible Information Standard: mandatory since 1 August 2016
https://www.england.nhs.uk/ourwork/accessibleinfo/
HEE library contribution during COVID-
19
https://library.nhs.uk/coronavirus-resources/https://kfh.libraryservices.nhs.uk/Covid-19-coronavirus/
Next steps:
Developing a cross-sector partnership
Informed, empowered and
healthy digital citizens:
Health literacy, underpinned
by digital literacy, for the 21st
Century
Thank you
@RuthCarlyle
Ruth.Carlyle@hee.nhs.uk
Contact us at KFH.England@hee.nhs.uk #HEELKS

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CILIP Conference 2020: Health Literacy: Knowledge for healthcare and building on your skills

  • 1. Health Literacy: Knowledge for Healthcare and building your skills Ruth Carlyle, Head of Library and Knowledge Services – East of England and Midlands, Co-Lead Health Literacy and Patient Information with NHS libraries, Health Education England Nov 2020 @NHS_HealthEdEng @NHS_HealthEdEng #HEELKS @RuthCarlyle
  • 2. Topics covered • Health literacy – what it means • Scale of the issue • Implications • How are you using health literacy skills in your life? • Do you know your rights as a patient? • Knowledge for Healthcare approach • Two techniques • Tips for signposting to health information • Where next?
  • 3. Let’s talk about health information • Have you ever searched for health information online? • Decided how many tablets you need to take? • Thought about whether to share health information through social media? • Worked out what you want to ask a health professional? • Followed the signs to get to the right department in a hospital?
  • 4. Health literacy The ability to access, assess and use health information to make health-related decisions
  • 5. What does it mean day to day?
  • 6. Need to understand how information is presented https://fullfact.org/health/mail-guardian-2m/
  • 7. How many people struggle with reading? 16.4% (or 1 in 6) of adults in England, and 17.9% (or 1 in 5) adults in Northern Ireland, have literacy levels at or below Level 1 (GCSE grades D-G) http://www.oecd.org/skills/piaac/
  • 8. 52 35 3538 40 41 44 44 46 National average 43% unable to understand written health information Scale of the issue: literacy (16-65 years) Rowlands et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/26009533
  • 9. 66 55 5455 59 60 60 62 64 National average 61% unable to understand health information when numbers included Scale of the issue: literacy and numeracy (16-65 years) Rowlands et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/26009533
  • 10. How much does it vary? Geodata on local health literacy Example of Cambridgeshire (percentage adults unable to follow health information that includes both words and numbers) http://healthliteracy.geodata.uk/
  • 11. Implications • Misunderstanding • Poor decisions • Exacerbated inequalities • Inappropriate use of medication • Ineffective access to health services • Poor health outcomes
  • 12. How far are you using health literacy in your own life? • 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 Don Nutbeam, 2000 https://academic.oup.com/heapro/article/15/3/259/551108
  • 13.
  • 14. 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
  • 15. Knowledge for Healthcare • Evidence for whole NHS workforce, not just learners • Libraries as business critical • Informing the design of roles and services • Focus on Health Literacy and Patient Information https://www.hee.nhs.uk/our-work/library-knowledge-services Approved strategy 2021-26
  • 16. E-learning on Health Literacy awareness developed with NHS Education for Scotland 15-minute Health Literacy introduction 1-hour Health Literacy awareness introduction, accredited by Royal Society for Public Health Health Literacy awareness training Health Literacy “train the trainer” training Ruth Carlyle & Sally James, HEE Midlands, September 2019
  • 17. Spoken communication: Teach Back 1. Communicator takes responsibility 2. Tell me 3. Re-explain as needed 4. Continue until both happy with understanding
  • 18. Ask 3 Questions 1. What are my options? 2. What are the pros and cons of each option for me? 3. How do I get support to help me make the decision that is right for me? https://www.pat.nhs.uk/downloads/patient-information-leaflets/other/Ask%203%20Questions%20Leaflet.pdf
  • 19. E-Learning • 35-minute programme • Action plan to include in CPD file • https://www.e- lfh.org.uk/programmes/health- literacy/ Jointly developed by NHS Education for Scotland and Health Education England
  • 20. “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
  • 21. 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
  • 22. - Is it dated (and less than 3 years old)? - Does it have a review date (and is it within that review date)? - Does it say who wrote it? - Does it give the evidence base? - Does it say who funded it? - Were users involved in developing and/or testing it? Before you signpost to health information
  • 23. Your right: Accessible Information format 1. Ask 2. Record 3. Flag 4. Share 5. Provide Accessible Information Standard: mandatory since 1 August 2016 https://www.england.nhs.uk/ourwork/accessibleinfo/
  • 24. HEE library contribution during COVID- 19 https://library.nhs.uk/coronavirus-resources/https://kfh.libraryservices.nhs.uk/Covid-19-coronavirus/
  • 25. Next steps: Developing a cross-sector partnership Informed, empowered and healthy digital citizens: Health literacy, underpinned by digital literacy, for the 21st Century

Editor's Notes

  1. Thank you for joining us for this session. I am going to be introducing you to some of the issues around health literacy, after which Bob Gann will give you more of the context around the underpinning issues of digital literacy. This is a session for anyone and for all of us, regardless of which sector you may work in. [Link – what we will be covering]
  2. We will be considering Health literacy – what it means Scale of the issue Implications How you are using health literacy skills Your rights as a patient Knowledge for Healthcare approach Two techniques – [I said 1 in the abstract, but we should have time for two] Tips for signposting to health information Where next [Let’s start by thinking about what you may already be doing in health information]
  3. So, starting with you… have you ever done any of these things? Have you ever searched for health information online? Decided how many tablets you need to take? Thought about whether to share health information through social media? Worked out what you want to ask a health professional? Followed the signs to get to the right department in a hospital? If you were doing any of these things, you were using health literacy skills [Link – so what do we mean by health literacy?]
  4. In summary, it is the ability to access, assess and use health information. How often are we doing this? Well, at the moment we are doing it everytime we step out of our front doors. [Link 2 m spacing]
  5. How many people understand the 2 metre signage? Would they understand 6 feet? Do they understand that it is in all directions? And what does it mean in the context of confusing messages and different interpretations of the same evidence base? Additional layer of 23 June announcements by the Prime Minister: “Where it is possible to keep 2 metres apart people should. But where it is not, we will advise people to keep a social distance of ‘one metre plus’, meaning they should remain one metre apart, while taking mitigations to reduce the risk of transmission.” It is further complicated by how we use the evidence behind either a 2 metre or a 1 metre plus social distancing [Link – 1 metre evidence]
  6. One political issue, for example, is the issue of the evidence behind 2 metres or 1 metre social distancing. Daily Mail – research in Lancet shows that 1m cuts your risk by 80% Guardian – research in Lancet shows cutting distance from 2m to 1m doubles risk Summary by Full Fact of research reported very differently in different papers. From what they found, they concluded with "moderate certainty" that keeping over a metre away from people with probable Covid, SARS or MERS cuts your risk of infection from about 13% (without physical distance measures) to about 3%. This is the roughly 80% reduction in risk that the Mail mentioned. The researchers also found that “for every 1m further away in distancing, the relative effect might increase 2·02 times”. A change from keeping two metres apart (which is currently advised in the UK) to a distance of only one metre might therefore double the risk, as the Guardian said. These issues have implications for individual understanding – and our ability to understand the information varies. [Link 43% and words]
  7. More recently, in 2015, the OECD conducted its Survey of Adult Skills, known as PIAAC (Programme for the International Assessment of Adult Competencies). This survey found that 16.4% (or 1 in 6) of adults in England, and 17.9% (or 1 in 5) adults in Northern Ireland, have literacy levels at or below Level 1, which is considered to be 'very poor literacy skills’. Much health information is pitched above this basic level – creating further complications. [Link 43% slide]
  8. National % of adult working age population: % unable to fully understand and use information: 43% [Link 61% words and numbers]
  9. 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% So, what might that mean in a locality? [Link Cambridgeshire]
  10. At the local level, we know that organisations will need to prioritise their efforts [Link implications]
  11. Health Literacy is so important because life expectancy is rising but health inequalities are increasing. We are living longer but not in good health. More likely to die young from preventable illness, and poor health could be related to poorer lifestyle, not taking up screening to prevent.   Misunderstanding Poor decisions Exacerbated inequalities Inappropriate use of medication Ineffective access to health services Poor health outcomes [so how are you using health literacy?]
  12. We all need to be able to do all the above for our own self-care, but we can also ensure that clinical colleagues and trainees with whom we are in contact are able to use tools that help We need to be aware that at different points of our life we can be at different levels. Just because we usually work at either interactive or critical level doesn’t mean we can’t move backwards to struggling to manage Function health literacy. You can have patient, careers and others who have high levels of health literacy around their chronic condition (diabetes, asthma, COPD) but they are then given another diagnosis (Cancer, stroke, other chronic condition) and their health literacy drops and they struggle to cope and engage. [what does this mean for evidence informed decisions in health – link Trish Greenhalgh]
  13. If we are going to have an evidence-based NHS and to make evidence-based decisions, we need to be able to access and use evidence. I am sure many of you have heard of Trisha Greenhalgh - the author of ‘How to read a paper'. Trisha Greenhalgh epitomizes evidence-based medicine However, when receiving a diagnosis….
  14. Catherine At diagnosis, or at a point of shock, health literacy goes down What are the implications of this [link]
  15. Health literacy techniques are part of the skills set of NHS library and knowledge services staff, to share with colleagues in other sectors. It forms part of the strategic direction for NHS library and knowledge services. As Health Education England, we do not manage the services We are part of a team delivering Knowledge for Healthcare as a strategic framework in the NHS. Knowledge for Healthcare is a 15 year strategy, with a framework for the first 5 years. In the first five years, we re-framed the role of library and knowledge services as key to an evidence-based NHS. We are now developing the framework for the next ten years. One area of focus will be Health Literacy and Patient Information. [Link suite of training]
  16. Looking at the full suite of resources, we have materials that range from the e-learning through to training trainers such as yourselves to deliver a full day of face to face training. In the current circumstances, we are not delivering face to face in the conventional way, but the resources are there for when we need them. We have train the trainer Full day health literacy One hour accredited by the Royal Society for Public Health 15 minute induction – and 35 minute e-learning [Teachback tools]
  17. 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?” [link Ask 3]
  18. Preparing for consultations – particularly important with online What are my options? What are the pros and cons of each option for me? How do I get support to help me make the decision that is right for me? [training – link e-learning]
  19. At the broadest level, we have the new E-Learning programme developed jointly by HEE and NES. It introduces the core concepts: Teach back; Chunk and check; Use pictures; Simple language; Routinely offer help. The resource is not accredited, but the action plan can be used as a resource both for reflection and for 35 minutes of CPD to add to a CPD file for ongoing validation in different professions. I would encourage you to use the E-Learning and to refer people to it. [link HEE health literacy toolkit]
  20. Range of resources: Business case Case studies Training materials “How to” guide [covers written as well as spoken communication]
  21. 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 [hints before you signpost]
  22. Whether it is information you have been given, or information that you have picked up, consider the quality of the information you have been given: Is it dated (and less than 3 years old)? Does it have a review date (and is it within that review date)? Does it say who wrote it? Does if give the evidence base? Does it say who funded it? Up to July 2021, some documents will have The Information Standard. This is a helpful short cut as a quality indicator. The Patient Information Forum is developing a new model for quality. [Link right to accessible information]
  23. Organisations have had a mandatory duty since August 2016 to check your access needs for information and to meet these needs: Ask people if they have any information or communication needs, and find out how to meet their needs. Record these needs clearly and in a set way. Highlight or flag in the person’s file or notes, so it is clear that they have information or communication needs and how to meet these needs. Share information about people’s information and communication needs with other providers of NHS and adult social care, when they have consent or permission to do so. Take steps to ensure that people receive information which they can access or understand, and receive communication support if they need it. [Link – ways HEE is making this easier]
  24. As the national team working with NHS Library and Knowledge services we collate information to support library staff. As an additional point during the pandemic, we are collating sources directly for the public Do signpost people to these sources What next for you – skills and signposting What next for us - partnership [link partnership]
  25. Developing a cross-sector partnership. Drawing on the skills and techniques of NHS library and knowledge staff to support the development of skills in other sectors. Health literacy increasingly needs to be underpinned by digital literacy, to be covered by Bob Gann [link to thank you and handover]
  26. Thank you – passing on to Bob Gann and questions at the end