Combatting low health literacy that’s affecting a quarter of Irish people

A new international health literacy survey has found that about one in four people (28 per cent) in Ireland have "limited" health literacy and struggle to find and evaluate health information. The same survey found that one in five people in Ireland find it difficult to judge whether they need a second opinion from another doctor on their health condition.

Eighteen- to 35-year-olds, people with poor social supports and those with financial difficulties or in poor health, were among those with lower than average levels of general health literacy, according to preliminary results from the World Health Organisation (WHO) Action Network on Measuring Population and Organisational Health Literacy (M-POHL) survey, which will be published in December.

Health literacy is defined as having “the ability to make sound health decisions in the context of everyday life – at home, in the community, at the workplace, in the healthcare system, the market place and the political arena”. Sometimes, people who do not experience literacy difficulties in other areas of life, can struggle to understand things in healthcare settings – partly due to the medical vocabulary but also due to feelings of emotional or physical vulnerability in the situation.

The WHO defines health literacy as the "capacity of an individual to access, understand, appraise and use health-related information". The National Adult Literacy Agency (NALA) says that health literacy is based on the simple concept of a "health provider such as a doctor, nurse or pharmacist communicating clearly and the patient understanding that information so that they can make informed health decisions".

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Clear communication

The importance of clear communication in plain English is particularly important for people whom English is their second language, and the M-POHL study found that immigration status is linked to low health literary in some countries. Limited health literacy could also be attributed to the low levels of Covid-19 vaccination among certain immigrant groups in Ireland.

A review by Yvonne Finn from the school of medicine at NUI Galway, published in the Irish Medical Journal, pointed out that the shift from the paternalistic model of doctor-patient relationship to a more patient-centred one can make assumptions of the patient's health literacy skills.

Limited health literacy is associated with poorer uptake of vaccinations, less engagement in disease prevention behaviours and increased use of acute hospital services. Higher rates of readmission to hospital and/or emergency department visits within 30 days of discharge were also found in patients with limited health literacy. People with limited health literacy have poorer knowledge of disease and medication, which can result in misinterpreting prescription instructions.

Presenting essential information first and limiting non-essential information improves comprehension in patients with limited health literacy. Avoiding the use of medical jargon and using health literary guidelines when preparing written patient information also improves the understanding of healthcare information for those with limited health literacy. Adding images or videos to verbal or printed material has also been found to improve understanding of healthcare information.

Asking questions

Following the publication of the preliminary results from the M-POHL study, the Irish Cancer Society teamed up with NALA to produce videos to help cancer patients and their families get the most out of interactions with health professionals. "Cancer patients with limited health literacy are less likely to attend appointments and are more likely to struggle with taking medicines correctly, be hospitalised and to die from their cancer," says a spokesperson from the Irish Cancer Society.

Siobhán Hayes, who features on one of these health literacy videos, says that a lack of health literacy can “create fear and lack of confidence”.

A public health nurse for many years, Ms Hayes encountered many people who were reluctant to admit that they had issues with health literacy. “Sometimes, patients wouldn’t understand the information I gave them about health promotion or medication so I would ask them to repeat back to me what I asked them to do,” she says. This so-called teach back or show back method is used by health professionals to confirm whether the patient understood what has been explained to them.

When Ms Hayes was diagnosed with endometrial cancer in 2017, she realised how important it was for her to ask questions about her own diagnosis and treatment when attending medical appointments. Asking questions is one way for patients to actively improve their own health literacy when dealing with health professionals.

“It’s a good idea to ask questions at the beginning of the consultation rather than when the doctor is heading out the door. Writing down your questions before you go into the appointment is also useful,” she says. She also advises people to bring someone else along with them for appointments. “You are told so much in a short space of time that it’s really hard to take it all in,” says Ms Hayes.

The new Irish Cancer Society videos deal with getting the most from your health appointment, getting test results and getting health information and support between appointments. They can be viewed here:https://www. cancer.ie/cancer-information-and-support/cancer-information/health-literacy-clearer-cancer-communication-for-better-health.

Ireland was one of 17 countries from the WHO European region that participated in the M-POHL survey. The full results are expected to be published in December. It will be interesting to see if health literacy has improved in European countries during the Covid-19 pandemic when frequent public health messages on how to prevent spread of the virus were communicated widely across various media.