Health Literacy: The Solid Facts
Stephan Van den Broucke
UC Louvain
Gérer sa santé : rêve ou réalité ?
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Mutualités Libres/Onafhankelijke Ziekenfondsen
Brussel, 31 Mei 2016
Healthy literacy
Not a new concept …
• The concept of « literacy »
-
To be literate = being “knowledgeable or educated in a
particular field or fields”
-
Increased attention since the mid 20th century
-
The ability to identify, understand, interpret, create,
communicate, compute and use printed and written
materials associated with varying contexts (UNESCO)
-
Applied to a range of competences deemed important to
function in the 21st century
• Application to the health sector in the 1970s
-
Emphasis on individual competences in the context of
health care (« medical health literacy»)
-
More recently enlarged and applied to disease
prevention and health promotion (« public health
literacy»)
… an extended concept …
Improved capacity to act
on social and economic
determinants of health,
improved community
empowerment
Community
Improved
capacity to
influence social
norms, and
interact with
social groups
Increased
participation
in
population health
programs
Imrproved knowledge of
health services, better
compliance with
prescribed actions
Improved individual
resilience to social
and economic
adversity
Improved capacity to
act independently on
knowledge, improved
motivation and selfconfidence
Basic skills in
reading and
writing
necessarry for
effective
functioning in a
health context
Ability to critically
analyze and use
information to
participate in actions
that overcome
structural barriers to
health
More advanced
cognitive literacy and
social skills that
enable active
participation in health
care
Individual
… a multidemensional concept
« A person’s knowledge, motivation
and competences to access,
understand, appraise, and apply
health information in order to make
judgments and take decisions in
everyday life concerning healthcare,
disease prevention and health
promotion to maintain or improve
quality of life during the life course»
WHO. Health literacy. The solid facts. Health, 2016.
Conceptual model of Health Literacy
Sørensen et al., Health literacy and public health: A systematic review and
integration of definitions and models. BMC Public Health. 2012;12:80
Importance of Health Literacy
• An outcome of health education
(as a strategy of health promotion)
• A determinant of the quality of health
care
• A determinant of health outcomes and
health care costs
• A mediator of the relationship between
SES / education and health outcomes
• A leverage to create and strengthen
health literacy friendly settings
Health Literacy as an outcome
of Health Education
Nutbeam, Evaluating Health Promotion – Progress, problems and
solutions. Health Promotion International, 1998, 13(1), 27-44
Health Literacy as a determinant
of the quality of health care
People with low health literacy
have difficulty to
• understand information provided by
health carers
• understand written health information
• find their way in the health care
services
• find their way in health insurance
• take control over their own health
Health literacy as a determinant
of health outcomes
• Outcomes of health care
People with low health literacy have
- lower adherence to recommendations for treatment
- less self care
- more chronic disease
- 1,5 times higher mortality (Baker et al., Arch Int Med, 2007).
• Outcomes of prevention
People with low health literacy
- have less healthy lifestyles
- participate less in screening
• Health care expenditure
More (unnecessary) use of health care services leads to
higher costs
– Between 143 $ and 7 798 $ extra per patient/year (Eichler et al, Int J Public
Health 2009)
– in The Netherlands estimated at 61 millions €
Health Literacy and perceived health
World Health Organization (2013). Health literacy. The solid
facts. WHO Regional Office for Europe: Copenhagen.
Health Literacy and physical activity
Health literacy as a determinant
of health outcomes
Duong et al. Asian Pacific Journal of Public Health 2015;1-10
Health Literacy and health care use (in Belgium)
GH = General hospital; PH = psychiatric hospital; ODC = One Day Clinic; ODSC = One Day Surgical Clinic; GP = General Practitioner; SP = Specialist Practitioner.
IRR = incidence rate ratio defined as eβ, where β is the regression coefficient.
Vandenbosch et al (2016) JECH
Health Literacy and health care costs (in Belgium)
GH = General hospital; PH = psychiatric hospital; ODC = One Day Clinic; ODSC = One Day Surgical Clinic; GP = General Practitioner; SP = Specialist Practitioner.
IRR = incidence rate ratio defined as eβ, where β is the regression coefficient.
Vandenbosch et al (2016) JECH
Health literacy as a mediator
between low SES and health
Van der Heide et al, Journal of Health Communication 18 (2013): 172-184
How can health literacy contribute
to health inequalities?
Low literacy may cause health disparities by
• reducing the accessibility to and the effectiveness of
medical care received
• reducing the likelihood that individuals are adequately
informed and activated with regard to healthy
behaviors
• increasing a person’s stress in addressing the
challenges of navigating through daily life
• diminishing an individual’s self-efficacy (i.e., the ability
to exert control over one’s life and surroundings)
Saha, Journal of General Internal Medicine, 2006, 21.8: 893-895.
Health literacy as a mediator between
education and health behaviour
•
Use of HLS-EU-Q16 on a representative sample of 9616 Belgians
•
Test of the mediating role of HL on the relationship between
education and behaviour
(Renwart & Van den Broucke, 2014)
Health literacy as a mediator between
education and health behaviour
Measuring Health
Literacy
• A large range of measures available, with important differences in
terms of objectives and target groups
• 122 instruments listed in the Health Literacy Tool Shed
• HL Screeing in a clinical context: Rapid Estimate of Adult Literacy in Medicine
(REALM), Test of Functional Health Literacy (TOFHLA), Newest Vital Sign (NVS)
• Population survey: National Assessment of Adult Literacy survey (NAAL), Health
Literacy Questionnaire
• European Health Literacy Survey (HLS-EU)
• Concept validated tool of 47 self-report items
• 12 sub-scales addressing difficulties in accessing, understanding, appraising and
applying information to make decisions in health care, disease prevention, and
health promotion
• Used to collect data on 8000 respondents in 8 EU countries
• Used on a total of 10,024 respondents in 6 Asian countries
(Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, Vietnam)
• Short forms of 16 and 6 items increasingly used
Current levels of health literacy
• USA
Nearly half of the adult Americans have difficutlty to understand
health information correctly (IOM, 2004)
• Europe
- 48% have a low level of health literacy
- 15% have difficulties in understanding their doctor’s explanation
- 23% are unable to correctly read the dose of medication
- 22% have difficulties finding information about illnesses
- 26% have difficulties finding information about the treatment of
illnesses
(HLS-EU, 2012)
• Asia
mean general health literacy index of 34.4 ± 6.6 on a scale of 50
in Taiwan (HLS Taiwan, 2014)
Current levels of health literacy
Health Literacy in Belgium
Wallonie
Bruxelles
LS insuffisante
LS limitée
LS suffisante
Flandre
Belgique
LS insuffisante
LS limitée
LS suffisante
What can be done
about low health literacy?
Measure personal HL
competences
Measure the fit of
HL competences
to demands
Improve individual and
population HL through
Education and training
Compensate for low
HL of disadvantaged
groups by specific
compensatory
measures
Measure situational HL
demands and support
Improve organizational HL by
reducing situational demands
and offering specific
institutional support
What can be done
about low health literacy?
A shared responsibility for
•
•
•
The health sector
Citizens
Policy makers
Address health literacy
Health sector
• Screening of low health literacy
• Adapt oral and written information in
care and prevention by
- balancing the depth of the information
provided
- checking comprehension
- visual support of the communication
- ensuring enough time for consultation
• Specific courses
e.g, self-management for chronic patients
• Communication training
• Use of social media
Address health literacy
Education and training
• Integration of health in educational
programmes, professional training,
and adult education
Policy measures
• Stimulate community development
• Specific actions for elderly and
disadvantaged groups or
communities
Create and strengthen
health literacy-friendly settings
1. Has leadership that makes health literacy integral to its
mission, structure, and operations.
2. Integrates health literacy into planning, evaluation measures,
patient safety, and quality improvement.
3. Prepares the workforce to be health literate and monitors
progress.
4. Includes populations served in the design, implementation,
and evaluation of health information and services.
5. Meets the needs of populations with a range of health literacy
skills while avoiding stigmatization.
6. Uses health literacy strategies in interpersonal
communications and confirms understanding at all points of
contact.
7. Provides easy access to health information and services and
navigation assistance.
8. Designs and distributes print, audiovisual, and social media
content that is easy to understand and act on.
9. Addresses health literacy in high-risk situations, including
care transitions and communications about medicines.
10. Communicates clearly what health plans cover and what
individuals will have to pay for services.
Create partnerships for Health Literacy
• Combine efforts to empower individuals and communities
to address health literacy
• Examples of partnerships
–
–
–
–
IUHPE Global Working Group on Health Literacy
Health Literacy Europe
Asian Health Literacy Association
National Alliance for Health Literacy (Netherlands)
more than 60 organizations: patients, providers, health institutions, health
insurance providers, academia, industry, business, …
– Multistakeholder Collaboration (Ireland)
– Well Done – MSD Health Literacy Awards
Well Done – MSD Health Literacy
Awards ceremony 2014
Conclusion
https://www.youtube.com/watch?v=fzMA9TlPJUk