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Health Literacy: Principles-Measures-Research-Policy

Health Literacy: Principles-Measures-Research-Policy. Dr Sarah Gibney FP7 Diabetes Literacy Consortium University College Dublin. Overview. Principles Background Definitions and components Measures (examples) Research Antecedents and consequences of poor health literacy

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Health Literacy: Principles-Measures-Research-Policy

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  1. Health Literacy: Principles-Measures-Research-Policy Dr Sarah Gibney FP7 Diabetes Literacy Consortium University College Dublin

  2. Overview • Principles • Background • Definitions and components • Measures (examples) • Research • Antecedents and consequences of poor health literacy • Key research areas • European Health Literacy Survey (inc. Ireland) • Action areas • Policy • Key Messages

  3. Background Background Increasing complexity of health systems and proliferation of health information From ‘industrial age medicine’ to ‘information age health care’ (Smith, 2006) Since the 1990s Rapid growth of interest internationally and in different health fields (Rudd et al. 2007) Growing evidence-base linking literacy to health status, behaviour, beliefs, outcomes Potentially a cost effective way of addressing health (Eicler et al. 2009) Reflects a rights-based approach to equality in healthcare (access and outcome)

  4. Health Literacy World Health Organisation (WHO) Perspective • Defined as cognitive and social skills which determine the motivation and ability of individuals to access, understand and use information in ways which promote and maintain good health • More than being able to read pamphlets and successfully make appointments • Goes beyond the concept of health education and individual behaviour-orientated communication • Addresses the environmental, political and social factors that determine health • By improving peoples’ access to health information and their capacity to use it effectively, health literacy is critical to empowerment • Links with international health and development goals

  5. Measuring Health Literacy

  6. What Should be Included When Assessing Health Literacy? Various definitions, however most concern Cognitive Capabilities, Skills and Behaviour Most reflect an individuals’ capacity to function in the role of a patient within the healthcare system (Sørensen et al. 2012)

  7. Health Literacy Measures (Examples)

  8. Condition and Population-Specific Health Literacy Measures Diabetes Numeracy Test (DNT-15); Literacy Assessment for Diabetes Asthma Numeracy Questionnaire Food Label Literacy for Applied Nutrition Questionnaire (FLLANK) Literacy Measure for Patients with HIV Spanish/Hebrew/Korean Health Literacy Test and Test for Singapore

  9. Antecedents

  10. Consequences Health Literacy as a Public Health Issue (Zarcadoolas et al. 2006)

  11. Key Research AreasResponding to the “Health Literacy Epidemic” “Nearly half the American population may have difficulties in acting on health information” (Institute of Medicine, 2004) • Emerging areas: • Role of health educators in promoting health literacy • Public health literacy for lawyers • Health communication • Prevalence of limited health literacy • Health literacy as an empowerment tool for low income mothers • Comparative research

  12. The European Health Literacy Survey Response to calls for internationally collaborative research (Protheroe et al. 2009) European Commission action areas include the promotion of health literacy programmes for different age groups Mismatch between concept of health literacy and measures of health literacy Link between poorer health outcomes and poorer use of health services now well established (Berkman et al. 2011) 8 Countries (Ireland, Greece, the Netherlands, Spain, Germany, Poland, Bulgaria, Austria) 2011; Ireland n= 1,005

  13. Integrated HLS-EU Model of Health Literacy Life course Sitauational Determinants Health service use Health costs Health behavior Health outcomes Understand Access Partici- pation Empower-ment Societal and environmental determinants Knowledge Motivation Competences Health promotion Disease prevention Health care Appraise Health information Personal Determinants Equity Sustain- ability Apply Individual level Population level

  14. Health Promotion Questions (Examples) • On a scale from very easy to very difficult, how easy would you say it is to … • Findinformation on how your neighbourhood could be more health-friendly? (Instructions: Reducing noise and pollution, creating green spaces, leisure facilities) • Understandinformation on food packaging? • Judge how your housing conditions help you to stay healthy? • make decisions to improve your health? • Take part in activities that improve health and well-being in your community?

  15. Disease Prevention Questions (Examples) • On a scale from very easy to very difficult, how easy would you say it is to … • Findinformation about how to manage unhealthy behaviour such as smoking, low physical activity and drinking too much? • Understandwhy you need vaccinations? • Judgehow reliable health warnings are, such as smoking, low physical activity and drinking too much? • Decidehow you can protect yourself from illness based on advice from family and friends?

  16. Healthcare Questions (Examples) • On a scale from very easy to very difficult, how easy would you say it is to … • Find information about symptoms of illnesses that concern you? • Understand what to do in a medical emergency? • Judge the advantages and disadvantages of different treatment options? • Use information the doctor gives you to make decisions about your illness?

  17. HLS-EU Questionnaire 47 questions: Index score created: 0-50 with thresholds Sub-indices by Domain: Health Care, Disease Prevention and Health Promotion (0-50 scale with thresholds) Sub-indices by information processing pathway: Access, Understand, Evaluate, Apply (0-10 scale, no thresholds)

  18. HLS-EU Questionnaire Additional Items Socio-demographic and socio-economic indicators (age, gender, education, marital status, children, employment, perceived income deprivation) Lifestyle and behaviour (exercise, smoking, alcohol consumption, height and weight (BMI), community engagement) Functional health literacy test (NVS-UK) Perceived social status Healthcare utilisation and self-reported health and disability status

  19. HLS-EU-Q Measurement Tools 47 Items (General; Domains; Information Processing) 16 Items (General) 6 Items (General) 3 Items - in development – (General)

  20. General Health Literacy Mean Scores by Age and Country *Pearson’s correlation coefficient,*p<0.05

  21. General Health Literacy Mean Scores by Functional Health Literacy (NVS SCORES) and Country *Pearson’s correlation coefficient,*p<0.05

  22. General Health Literacy Mean Scores by Perceived Social Status and Country *Pearson’s correlation coefficient,*p<0.05

  23. General Health LiteracyMean Scores by Financial Deprivation and Country *Pearson’s correlation coefficient,*p<0.05

  24. General Health Literacy IndexMean Scores by Self-Assessed Health and Country *Pearson’s correlation coefficient,*p<0.05

  25. SummaryGeneral Health Literacy (Europe)

  26. The Curious Case of Health Literacy and Health Behaviour • Functional health Literacy and Reading Ability-based Measures • No association / inconsistent patterns (BMI, alcohol consumption) • Frequent negative association (smoking) • These measures focus on understanding health information only • Some aspects of health literacy are more related to health behaviours than others • Diseaseprevention • Health promotion • Healthcare • Information Processing pathways; what matters for behaviour? • Accessing, understanding, evaluating, applying

  27. Other Considerations … Gender: Is the relationship between HL and behaviours the same for men and women? Eg. Alcohol Age: Patterns drinking behaviour and smoking initiation/continuation differ across the life course Social Context: Cultural norms around activity, smoking, alcohol consumption Social Gradient: HL correlated with education and SES (financial deprivation, perceived social status) Health Literacy Gradient: Is the relationship between HL and HB the same at all level of health literacy? Functional / General Health Literacy Disease Prevention Health Promotion Health care Evaluating Accessing Understanding Applying

  28. Health Literacy and Health Behaviour among People aged 50+ in Ireland

  29. Health Literacy and Health Behaviour among People aged 50+ in Ireland

  30. Information Processing Pathways and Health Behaviour (Smoking and Alcohol)

  31. Health Promotion and Health Behaviours What Research can Add • Medical education historically relied on rational choice model; people choose to pursue behaviours needed for health • Misses key sources of influence • Behaviour should be understood in the broader context: social class/SES, financial constraint, health beliefs, self-efficacy, stress, social support • Research identifying areas within health literacy which are more associated with behaviour offers greater opportunity to support behavioural change: • Health Promotion, Disease Prevention • Skills in the area of evaluating, applying and finding health information

  32. Current Areas of Health Literacy Research in Ireland

  33. Health Literacy on the Policy Agenda • Area of priority action in the European Commission’s Health Strategy 2008-2013 • Ireland • National Adult Literacy Agency research and policy recommendations (McCarthy & Lynch, 2002; National Adult Literacy Agency 2009; Health Service Executive & National Adult Literacy Agency 2009; Lynch, 2010) • National Health Literacy Advisory Panel • Healthy Ireland (2013-25) National Framework for Health and Wellbeing • Policy adopted a social determinants of health framework • Reducing health inequalities associated with education and social inclusion • Strengthen health literacy to empower individuals and communities in reducing these health disparities (2013-25)

  34. Key Messages • Concept and definition • Cognitive and social skills which determine the motivation and ability of individuals to access, understand and use information in ways which promote and maintain good health • Measures • Increasing number of disease and population specific measures to address research priority and question • Research • Macro (health system) – meso (health conditions) – micro (individual behaviour) • Spans multiple disciplines (public health, health economics, psychology, social policy, sociology, equality, gender studies) • Policy • Strengthen health literacy to empower individuals and communities in reducing these health disparities associated with education and social exclusion (Healthy Ireland: 2013-25)

  35. Thank you • Acknowledgements: • The HLS-EU Consortium • Royal Irish Academy • NALA and the Health Literacy Advisory Panel • Contact: sarah.gibney@ucd.ie • Questions …

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