Community Health & Learning Foundation/Prostate Cancer UK

Health Literacy and Prostate Cancer Information: A Case Study

Who Are We?

• Anneliese Levy, Senior Information Development Officer, Prostate Cancer UK

• Jonathan Berry, Director, Community Health & Learning Foundation

What is Health Literacy?

Health literacy implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions. Thus, health literacy means more than being able to read pamphlets and make appointments. By improving people’s access to health information, and their capacity to use it effectively, health literacy is critical to empowerment.World Health Organisation

Health Literacy – the theoretical framework

Conceptual thinking about Health Literacy has developed in the last decade. Three types or levels of Health Literacy have been put forward for consideration:

• Functional - Basic or core knowledge of risks and health services, compliance with prescribed actions and ability to complete or comply with systems and procedures and access, prompted, basic web based sites and information;

• Interactive - Improved capacity and skills to act independently on knowledge, improved motivation and self-confidence, ability to chose between sites and web based information and to support others;

• Critical - Improved individual resilience to social and economic factors and capacity to review information critically and to challenge

Nutbeam D. The evolving concept of Health Literacy. Social Science and Medicine. 2008 December;67(12):2072-8.

Something you may not know

• 43% of adults (18-65) do not have adequate literacy skills to routinely understand health information.

• 61% of adults (18-65) do not have adequate numeracy skills to routinely understand health information.

(LSBU Press Release – December 2012)

Skills for Life

Skills for Life is about everyday English and practical maths. The most common definition of Skills for Life is:

“The ability to read, write and speak in English and to use mathematics at a level necessary to function and progress at work and in society in general”.

How big is the problem?Functional literacy in England

• Functional literacy = level 1 and above

• Level 1 = GCSE grades D-G. Adults with skills below this level may not be able to read timetables or letters containing words with more than one syllable

• 15% (=7.45 million people) of the population are below this level

• Entry level 1 = expected national school curriculum level for 5-7 yrs. Adults below Entry Level 1 may not be able to write short messages to family or select floor numbers in lifts

• 5% (=2.5 million people) are at this level

2011 Skills for Life Survey: Headline findings. Department of Business Innovationand Skills.

How big is the problem?Functional numeracy in England

• Functional numeracy = entry level 3 and above

• Entry Level 3 = expected national school curriculum level for ages 9-11. Adults with skills below this level may not be able to understand price labels on pre-packaged food or pay household bills

• 23.7% of the population are below this level

• 6.8% are at entry level 1 or below (national school curriculum for attainment at age 5-7 yrs)

2011 Skills for Life Survey: Headline findings. Department of Business Innovation and Skills.

Literacy: What Does It Mean?

• Below Level 1 – can’t find relevant information in leaflets (approx 5m)

• Below Entry 3 – can’t explain straightforward feelings/symptoms over the phone (approx 1.7m)

• Below Entry 2 – can’t follow a simple letter from the surgery (approx 1m)

• Skilled for Health: Making the Case (2006) Berry, J et al

Numeracy What Does It Mean?

• Below Level 1 – can’t work out mean (average) calorie intake (approx 14m)

• Below Entry 3 – measure and record height and weight on a chart (approx 6.5m)

• Below Entry 2 – work out how many tablets to take in a week (approx 1.5m)

• Skilled for Health: Making the Case (2006) Berry, J et al

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The impact of LLN needs on healthPeter

Radiology

Podiatry

Gynaecology

PaediatricsOrthopaedicsOncology

Pathology

Psychiatry

Rehabilitation

Physiotherapy

Pharmacy

Prosthesis Urology

Does it Matter?

• Those with the lowest skills have the worst health outcomes – premature mortality/morbidity

• Therefore those with lowest skills and health literacy are the biggest users of service

Prostate Cancer UKAccessible resources project

Prostate Cancer UK Information

Providing information• Prostate Cancer UK provides free information on prostate cancer and prostate problems that can be tailored to the needs of each man

• All information is evidence-based and independently reviewed

Available as printed copies and can be downloaded from www.prostatecanceruk.org

Prostate Cancer UK Headlines

Prostate cancer facts • Prostate cancer is the most common cancer in men

• Over 40,000 men are diagnosed with prostate cancer every year

• Over a quarter of a million men are living with and after prostate cancer

• 1 in 9 men will get prostate cancer

• More than 10,000 men die every year from prostate cancer

• It’s estimated by 2030, prostate cancer will be the most common cancer [1]

[1]http://www.cancerresearchuk.org/cancer-info/cancerstats/incidence/projections/selected-cancers/selected-cancers

Prostate Cancer UK

Who are your audience?

Bob is living below the poverty

line

Geoff has a learning disability

Mukesh is 89 years old

Prostate Cancer UK

Deciding what to do next...Scoping research

Looked for companies/organisations to work with

Commissioned production of a sample easy read product

Looked for ways to test the product

Worked with Community Health & Learning Foundation

Prostate Cancer UK

Who

• Focus Group 1 – Clients of Leicestershire Probation Service

• Focus Group 2 – Clients of Leicestershire Aids Support Service

Key Findings - Poster

Significant Understanding but

• Diagrams caused confusion/provoked more questions

• Risk association words/numbers– e.g. “may”, percentages – not well understood

• Age risk confusing

Key Findings - Leaflet

• Significant Understanding but

• Breast Cancer section not at all understood

• Not clear if only African/Caribbean and White Men are at risk

Key Findings - Diagrams

• Not human

• Looks like a “water cooler”

• Not realistic

• Needs simple words to explain it

Key Findings – Video Clip

• Professional

• Well understood

• Right length/keeps your attention

• Doesn’t tell you what to look for – signs/symptoms

Prostate Cancer UK

Next steps…Using findings from the focus group to guide us

Writing text in-house

Commissioning an illustrator to draw pictures to specification

Learning disability team helping us with wording

Re-testing along the way

Prostate Cancer UK

A bit of a learning curveThink about what skills and resources you already have in your organisation

If working with an external company brief them in detail

Test with your audience and find experts to work with