Health literacy and health information in England: how big is the problem?

Presentation to the Health Literacy Group UK Seminar‘Improving health information to promote health literacy’

Gill Rowlands, Professor, University of Newcastle and Aarhus University

March 2015

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Acknowledgements

• Co-researchers / co-workers

Dr Jo Protheroe, Keele University

Dr Marty Richardson, University of Liverpool

Dr Paul Seed, King’s College London

Dr John Winkley, AlphaPlus

Dr Rima Rudd, Harvard University

• Funders: MSD

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This presentation

• What are the levels of functional health literacy in England?

• What impact does this have on patients, the public, the NHS?

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Levels of functional health literacy in England

• Project funded by MSD: ‘Defining and describing the mismatch between population health literacy and numeracy and health system complexity’. Rowlands G, Protheroe J, Winkley J, Seed PT, Richardson M, Rudd R. (Submitted for publication)

• Sampled health materials commonly used to promote and protect health, manage illness, prevent disease or navigate services: 64 materials sampled

• The extent to which the sampled materials were representative of materials in everyday use in the English health service was rated by a panel of experts

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Example: Bowel Cancer Screening Kit

• The literacy and numeracy difficulty of materials were rated against the English Skills Qualification Framework

• A competency threshold was identified: having the skills to fully understand and use 70% of materials

• Data from the 2011 English national literacy and numeracy survey, which tested people against the English Skills Qualification Framework, were analysed to see what proportion of the population had literacy and numeracy skills below the competency threshold required to fully understand and use the materials we had sampled.

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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 independentlyInformation 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 complexityaccurately and independentlyInformation of varying length and detail

Material level

Population level

Skills QualificationFramework

Literacy

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, canindependently select and compare relevant information from a variety of sources

Material level

Population level

Skills QualificationFramework Numeracy

National Qualifications level: Literacy level 1 / Numeracy level 1Key Stage Skill Equivalent Ages:

Literacy 11-14 years, Numeracy 11-14 yearsNumber (%) English adults 16-65 yrs. UNABLE to understand and use this:

21 million people (61%)

Example: Bowel Cancer Screening Kit

National and regional picture: % of adults aged 16-65 years for whom health information is too complex

52

35

3538

4041

44

44

46

National average43%

Text (literacy) component of health materials

National and regional picture: % of adults aged 16-65 years for whom health information is too complex

66

55

5455

5960

60

62

64

National average61%

Text (literacy) ANDNumeracycomponent of health materials

Gender Age Ethnicity

Birthplace First language Qualifications

Employment status

Job grade Income

Home ownerArea

deprivation level

Demographic characteristics of those at highest risk of being below the health literacy threshold

Male (literacy)

Female (numeracy)

Aged 45+ BME

Born outside of the UK

English not first language

Below expected by

age 16

UnemployedLowest job

gradeIncome less

than £10,000

Not a home owner

Top 5 most deprived areas

Not statistically significant when considered together

Impact on patients and the public: illness

People with lower health literacy :• Have higher mortality (older people)1

• Have more difficulty managing medication1

• Have a higher prevalence of long-term conditions (LTCs)2

• LTCs more likely to be limiting2

• Are less likely to engage with disease prevention e.g. cancer screening, immunisation1

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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

Impact on patients and the public: wellbeing

People with lower health literacy / education level have

• More unhealthy behaviours; alcohol, poor diet/obesity2,3, smoking3

• Fewer healthy behaviours; good diet/normal weight2,3

• Lower levels of self-rated health1,2

• Lower response to public healthy living campaigns3

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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.

Conclusions

• Low health literacy is a problem for many people in England.

– Nearly half the population (4 out of 10) cannot fully understand and use health information, rising to 6 out of 10 when the information contains both text and maths.

– Some groups within the population, and some parts of the country, face more difficulties than others

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Conclusions

• Low health literacy has a clear association with poorer health and greater risk of illness

• Improving health information and health communication can help to reduce the problems brought through low health literacy

• In parallel we need to support the development of health literacy skills, particularly for those in the most disadvantaged groups

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Health literacy and health information in England: how big is the problem?

Gill RowlandsGill.Rowlands@folkesundhed.au.dk

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