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Debat Health Literacy Onafhankelijke Ziekenfondsen.
- 1. Health Literacy: TheSolid Facts Stephan Van den Broucke UC Louvain Gérer sa santé : rêve ou réalité ? Gezondheidsinfo : een doolhof? Mutualités Libres/Onafhankelijke Ziekenfondsen Brussel, 31 Mei 2016
- 2. Healthy literacy Not anew 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»)
- 3. … a multidemensionalconcept « 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.
- 4. Conceptual model ofHealth Literacy Sørensen et al., Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12:80
- 5. Importance of HealthLiteracy • 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
- 6. Health Literacy asan outcome of Health Education Nutbeam, Evaluating Health Promotion – Progress, problems and solutions. Health Promotion International, 1998, 13(1), 27-44
- 7. Health Literacy asa 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
- 8. Health literacy asa 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)
- 9. Health Literacy andperceived health World Health Organization (2013). Health literacy. The solid facts. WHO Regional Office for Europe: Copenhagen.
- 10. Health Literacy andphysical activity
- 11. Health Literacy andhealth care use (in Belgium) Vandenbosch et al (2016) JECH 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.
- 12. Health Literacy andhealth care costs (in Belgium) Vandenbosch et al (2016) JECH 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.
- 13. Health literacy asa mediator between low SES and health 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.
- 14. Health literacy asa mediator between education and health behaviour (Renwart & Van den Broucke, 2014) Test of the mediating role of HL on the relationship between education and health related behaviour in 9616 Belgians
- 15. • A largerange 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 Measuring Health Literacy
- 16. Current levels ofhealth literacy
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- 18. What can bedone about low health literacy? Measure personal HL competences Measure the fit of HL competences to demands Measure situational HL demands and support Improve individual and population HL through Education and training Compensate for low HL of disadvantaged groups by specific measures Improve organizational HL by reducing situational demands and offering institutional support
- 19. Addressing low healthliteracy A shared responsibility for • The health sector • Citizens • Policy makers
- 20. Improve individual and populationHL 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
- 21. Compensate for lowHL by measures in the 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
- 22. Creating and strengthening healthliteracy-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.
- 23. Create partnerships forHealth 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
- 24. Well Done –MSD Health Literacy Awards ceremony 2014
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Editor's Notes
- #17 CF HLS-EU studie