1 / 19

Health literacy and SDM: thinking in terms of capabilities

Vikki Entwistle Presentation at Newcastle University, 13 May 2013. Health literacy and SDM: thinking in terms of capabilities. Joke literacy?. What did the buffalo say to his son when he went to college? Bison. What ’ s the link between health literacy and shared decision making?.

huong
Download Presentation

Health literacy and SDM: thinking in terms of capabilities

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Vikki Entwistle Presentation at Newcastle University, 13 May 2013 Health literacy and SDM: thinking in terms of capabilities

  2. Joke literacy? What did the buffalo say to his son when he went to college? Bison

  3. What’s the link between health literacy and shared decision making? • How do we understand the terms? • What kind of question do we think we’re being asked? Thinking in terms of capabilities can be helpful for thinking about health literacy and shared decision-making

  4. Health literacy … (1) • represents the cognitive and social skills…(Nutbeam / WHO, 1998) • is a constellation of skills…(AMA, 1999) • is the degree to which individuals have the capacity… (Ratzan & Parker, 2000) Something individuals somehow ‘have’, BUT…

  5. My literacy for dining out I use written menus easily in anglophone restaurants! Je peux demander du pain et du vin en France 我会饿死中国不识字 It’s not just me and my skills

  6. Health literacy is situation sensitive The literacy a person NEEDS, and the literacy a person HAS, to engage with their health and health care can both depend on their particular health issues and how healthcare is provided.

  7. Do I have sufficient health literacy for Shared Decision Making? • A decision-aid full of big words and statistics that I can’t interpret • A doctor who doesn’t seem interested, puts me off asking questions, makes me feel stupid • A decision-aid that helps me understand the key issues • A doctor who cares, invites questions, sees and helps me see that my views matter It depends! Will I be seeing:

  8. Which comes first? • Health literacy is useful for shared decision-making • Sharing decision-making develops health literacy

  9. Sharing decision making can support health literacy Broader view of SDM emphasises: • Enablement of participation • Range of senses in which decisions can be shared • Diverse forms of decision support • Staff interacting responsively • Support for autonomy-capability (understood relationally) Positive learning for now and for the future Entwistle et al J R Soc Med 2012; 105: 416-421

  10. Health literacy … (2) • … to gain access to, understand and use information in ways which promote and maintain good health(Nutbeam / WHO, 1998) • … to perform basic reading and numerical tasks required to function in the health care environment (AMA, 1999) • … to obtain, process and understand basic health information and services needed to make appropriate health decisions(Ratzan & Parker, 2000)

  11. A few concerns • On some definitions, measures, interpretations a person’s health literacy depends on their: • Making particular choices • Conforming to health behavioral norms • The aspirations associated with higher ‘critical’ health literacy can be obscured • Some ways of thinking render the promotion of health literacy vulnerable to hijacked for oppressive healthism

  12. Some challenges for talking about and assessing health literacy • Health literacy consists in something like capacity, skills, abilities. • We talk about the health literacy of individuals, BUT • Health literacy is partly a product of healthcare environments and the technologies/cultures of communication and interaction. • Health literacy can be understood as being valuable FOR a range of purposes.

  13. Thinking in terms of “capabilities” might help

  14. Capabilities approach Approach to thinking about: Quality of human lives Advantage/disadvantage Developed for work on: Issues of justice Human development, social policy Associated particularly with: Amartya Sen Martha Nussbaum

  15. Basic concepts and core idea Functionings Doings and ways of being Capabilities Genuine freedoms, opportunities, powers to achieve particular functionings What’s needed for a good human life is capabilities for valued functionings

  16. Some important features of capabilities thinking Broad evaluative space Pluralism about what matters Normative individualism Each person is ethically significant Emphasis on freedom Relational ontology Capabilities are socially shaped Dynamic complexity Interconnected capability networks

  17. ‘Applying’ these ideas Thinking of health literacy as a capability (or cluster of capabilities) could encourage recognition of: • ‘external’ as well as ‘internal’ constituents • dynamic and complex nature • multiple links to other capabilities and functionings (including SDM) • different valuations and priorities

  18. Capabilities thinking creates challenges for the assessment of health literacy… But it could help us: discuss the complexities of health literacy and SDM and ‘get real’ about the issues and practicalities of promoting both?

  19. Thank you • vikki.entwistle@abdn.ac.uk

More Related