Health literacy

Impact and action at a national level

26 July, 2014

Nicola DunbarDirector, Strategy and Development

What is health literacy?

HEALTH LITERACY

Skills / Abilities Demands / Complexity

Parker R, Measuring health literacy: Why? So what? Now what? In: Hernandez L (ed), Measures of Health Literacy: Workshop Summary; Roundtable On Health Literacy, 2009.

What is health literacy?

• Individual health literacy:• The skills, knowledge, motivation and capacity of a person to

access, understand, appraise and apply information to make effective decision and about and health care and take appropriate action

• Health literacy environment:• The infrastructure, policies, processes, materials and

relationships that make up the health system and have an impact on the way in which people access, understand, appraise and apply health-related information and services

Individual health literacy in Australia

• 59% of Australians have a level of individual health literacy that is below the “minimum required for individuals to meet the complex demands of everyday life”

• Influences tasks such as:• reading and understanding medication instructions• completing consent forms• finding a healthcare provider and making an appointment• understanding signage

Australian Bureau of Statistics. Health Literacy, Australia, 2008.

Health literacy by state

NSW Victoria Queensland SA WA Tasmania NT ACT Total population0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Less than minimum At least minimum

Australian Bureau of Statistics. Health Literacy, Australia, 2008.

Is this a problem?

• People with low levels of individual health literacy:• more likely to have poorer outcomes• less likely to use preventive services• more likely to be hospitalised• poorer medication adherence• poorer knowledge and understanding of their own condition• less likely to attend appointments• for older people – poorer overall health status and higher risk of

death

Berkman et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review, 2011

Bush et al. Advancing Health Literacy Through Primary Health Care Systems, 2010

Is this a problem?

• Complex health system:• who to see for what problem• how to navigate among many potential care providers

• Complex health services:• how to find your way in a hospital• what to do before / during / after a visit to a GP or specialist

• Complex interactions:• asking questions• sharing decision-making

• Complex information:• medicines information, informed consent, discharge instructions• many sources of information – what can be trusted?

What is happening at a national levelabout health literacy?

• 1990s – National Health Goals and Targets• 2010 – Australian Framework for Safety and Quality in

Health Care• 2012 – Australian Goals for Safety and Quality in Health

Care

What is happening at a national levelabout health literacy?

• National health literacy stock take 2011-12:• 66 submissions – over 200 separate initiatives

• Many different organisations doing work to improve health literacy

• A range of different approaches being used• Efforts fragmented with little potential for learning

Types of strategies and approaches

Health information49%

Research and knowledge sharing

21%

Building individual health literacy

14%

Workforce training7%

Health literacy envi-ronment

5%

Policy or framework4%

A national approach to addressinghealth literacy

Embedding health literacy into

systems

Integrating health literacy into education

Ensuring effective communication

People are able to access,

understand and act on health-

related information

Strategies for addressinghealth literacy

• Embedding health literacy into systems:• high level systems – standards, curricula, government policy• organisational policies and procedures

Strategies for addressinghealth literacy

• Ensuring effective communication:• appropriate health-related information• information when people need it, and in the form that they need it• effective interpersonal communication – education and recall,

shared decision-making

Strategies for addressinghealth literacy

• Integrating health literacy into education:• education and training for consumers about health and health

literacy – children and adults• education and training about health literacy for healthcare

providers – needs vary depending on role• education and training to improve communication

Everyone has a role in addressinghealth literacy

Consumers, patients and families

• Discuss with healthcare providers any difficulties in understanding information

• Ask for more information about any part of care that is unclear

Healthcare providers

• Assume most people will have difficulty understanding and applying complex health knowledge and concepts

• Use a range of communication strategies to ensure information is understood

Healthcare organisations

• Develop and implement health literacy policies and programs

Governments • Raise awareness about health literacy• Embed health literacy principles into health policy

development

Education and training organisations

• Provide education for healthcare providers about health literacy and communication

• Develop education programs for consumers

Where to next?

• Addressing health literacy in a comprehensive way requires long term strategies

• Opportunities for coordinated national action to:• raise profile of health literacy• reach agreement on where and action can be taken• integrate health literacy into policies and programs• examine how best to measure health literacy• support health care organisations and providers to improve

health literacy environment• examine how consumer organisations can support efforts to

address health literacy• promote research that addresses health literacy

Where to next for the Commission?

• Endorsement of national statement on health literacy and safety and quality by Health Ministers

• National action to raise awareness and foster a climate of action and collaboration

• Tailored resources for different groups• Linking health literacy and the National Safety and

Quality Standards

Standard 7Blood and Blood

Products

Standard 10Preventing Falls and

Harm from Falls

Standard 1Governance for Safety and

Quality in Health Service Organisations

Standard 2Partnering withConsumers

Standard 4Medication Safety

Standard 3Healthcare AssociatedInfections

Standard 8Preventing and

Managing Pressure Injuries

Standard 9Recognising and

Responding to ClinicalDeterioration in Acute

Health Care

Standard 5Patient Identificationand ProcedureMatching

Standard 6ClinicalHandover

National Safety and Quality HealthService Standards – from January 2013

The clinical workforce providing information about blood and blood product treatment options, and the

associated risks and benefits

Informing patients and carers about the risk of

falls and falls prevention strategies

Implementing processes to enable partnership with patients in decisions about their care

Consulting with consumers on patient information distributed by the organisation

Information on medicines is provided in a format that is understood and meaningful

Patient infection prevention and control information is evaluated to determine if it meets the needs of the target audience

Informing high-risk patients and their carers about the

risks, prevention strategies and management of

pressure injuries

Providing information to patients about how they

can raise concerns about potential

deterioration

National Safety and Quality HealthService Standards and health literacy

Summary

• Health literacy is a safety and quality issue• There has been a lot of work in Australia for some time,

but it is fragmented• Commission is starting to coordinate a national

approach:• embedding health literacy into systems• ensuring effective communication• integrating health literacy into education

• Everyone has a role in addressing health literacy

• nicola.dunbar@safetyandquality.gov.au• www.safetyandquality.gov.au