Low literacy levels puts lives at risk

Low health literacy levels cannot be ignored by service providers. More than half the population of Ireland have low literacy skills. Evidence of this can be seen on signs displayed around towns and cities, and in shops and restaurants. Signs seen in Galway recently show that punctuation, spelling, and words to describe something are often wrong. For example, a clothes shop displayed a garment labelled "dress with sequence €50". Presumably this should have read "sequins". A sign for Galway's West End has no apostrophe.

According to the National Adult Literacy Agency (Nala) literacy is about more than the ability to read and write. "It involves listening, speaking, reading, writing, numeracy, and using everyday technology to communicate and handle information. Literacy is an important determinant of health literacy, essential for good health."

Literacy levels impact on the ability of adults to engage in society. The Positive Ageing 2016 National Indicators Report shows that many people aged between 16 and 65 have low literacy skills. Indicators are based on the percentage of adults categorised as being at or below Level 1 literacy skills proficiency. More than half of 16 to 19 year olds and almost two thirds of people aged between 55 and 65 have low literacy skills. Level 1 is very basic and comprises tests such as showing a picture of an ear and asking the person taking the test whether it is an egg, lip, or ear. Another question asks whether sentences make sense such as "A comfortable pillow is soft and rocky." According to Nala "being at or below Level 1 indicates that a person has profound literacy difficulties. At this level a person may have difficulty identifying the correct amount of medicine to take from the information found on the package."

General literacy levels determine health literacy, which is the degree to which individuals have the capacity to obtain, process, and understand health information needed to make appropriate health decisions. The European Health Literacy Survey 2012, Results from Ireland, found that nearly 40 per cent of respondents had inadequate or problematic health literacy. Only one in five had excellent health literacy skills. Almost half of respondents found it difficult to judge the reliability of health information from the media. The report found that there are "alarming links between low levels of health literacy and health outcomes" and "inadequate health literacy predicts all-cause mortality". The report concludes that individuals with poor literacy must be identified when they enter the health system and "steps taken to counter this risk factor immediately".

Using jargon puts lives at risk. Civil servants in the UK have been banned from using words like "deliver", "tackling" and "going forward", frequently used by HSE managers. These meaningless terms should also be banned in Ireland. In 2015 the Health Information and Quality Authority (Hiqa) published guidance for providers of health and social care services, Communicating in Plain English, to help them communicate more clearly with service users and their families. There are versions for providers of both adult and child services. Simple tips include: not handing out forms immediately but having brief conversations first; telling service users what the form will be used for, and offering to help them fill in the form. Instead of asking "do you have any questions" say "what questions do you have?"

International studies show that health literacy interventions are a cost-effective way to improve health outcomes and patient safety. For example, a US project involving 7,200 low-income families who used hospital emergency departments for routine care, reduced unnecessary visits by more than 50 per cent. Families were provided with self-help health books written at third grade level and parents were trained in how to deal with health problems. Another New York City literacy project reduced depression among service users by half and increased moderate exercise level by 135 per cent. Low health literacy has been associated with worse glycaemic control in patients with type 2 diabetes.

The Department of Health's Healthy Ireland: A Framework for Improved Health and Wellbeing 2013-2025 aims to improve health literacy, including social media literacy by strengthening "self-esteem, resilience, and responses to social and interpersonal pressure". It also intends to "address and prioritise health literacy in developing future policy, educational and information interventions". Improving health literacy should help reduce the numbers of people using emergency departments and languishing on trollies. However, given the current massive demand for hospital and community services and the pressures on stressed out staff, it is unlikely that health literacy will be given the attention it deserves any time soon.