Health Care Where People Live and Work
The World Health Organisation (WHO) originally proposed a definition for health literacy that was later adapted by Nutbeam (1998) as ‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health’. Health literacy is essential in health care, as it allows individuals to access available health services and actively participate in the decisions and management of their health and wellbeing (Institute of Medicine, 2004).
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In recent years there has been an increase in chronic illness largely associated with an ageing population. This is placing immense pressure on health systems throughout Australia (Department of Health and Ageing, 2012). Addressing the barriers to improved health literacy in older adults would lead to better health and wellbeing outcomes, while simultaneously reducing the level of dependence on the health care system. The health professional plays an important role in assisting elderly patients to develop a greater understanding of their specific health conditions, and therefore, allowing elderly people to take an active role in the management of their health conditions.
Health literacy is more than possessing the ability to read and write, it encompasses an active role in accessing available health care services, self-care of chronic conditions and maintaining an adequate level of general health and wellbeing (Institute of Medicine, 2004). According to the Australian Bureau of Statistics (ABS) report on social trends (2009), 59% of Australian adults have inadequate health literacy levels, and this figure is even higher in the Tasmanian population (63%). This essentially means that the majority of people, even those with university degrees or higher education, fail to understand basic health information, such as, safe drug and alcohol use, disease prevention, first aid and sustainable wellbeing (Australian Bureau of Statistics, 2009).
Poor health literacy affects patients in various ways including; inability to accurately remember information provided by health professionals, less knowledge of the causes of ill-health, less likely to use health services designed to prevent and detect conditions (e.g. cancer screening, childhood health assessments and immunisations), and are more dependent on healthcare providers (e.g. hospitals and emergency services) (Australian Bureau of Statistics, 2009). Numerous tests have been developed to determine an individual’s level of health literacy, such as, the Newest Vital Sign (NVS), a nutrition label based test that takes approximately three minutes to complete. Other general indications of poor health literacy are; avoiding paperwork, using appearance to identify medications rather than labels, and a reluctance to complete forms.
Health literacy is an essential component of Primary Health Care (PHC). PHC aims to promote health, develop communities, act as an advocate for health services, provide rehabilitation, prevent illness, and care for the sick. (Australian Primary Health Care Research Institute, 2006). Health literacy can be improved by implementing various PHC strategies that are concentrated on addressing the social determinants of health, such as, social support, unemployment, early life and the social gradient (Wilkinson and Marmot, 2003). These strategies are focused on the promotion of health literacy skills and educating those in need, for example, free access to general practitioners (GP) and better health education in early schooling, are crucial programs in achieving improved education and health literacy outcomes.
The relationship between education and good health is well established in the literature and is documented in a wide variety of research articles (Black, 1980). Education leads to improved general and health literacy, which creates a greater chance of better health and wellbeing in an individual. However, it is important to note that, as Nutbeam (2000) explains, while an individual may have access to education and possess high general and health literacy levels, this does not guarantee better health outcomes. Older adults in the Australian population are among those with the highest rates of chronic illness and lowest rates of health literacy, therefore, improving health literacy is essential to better manage chronic illnesses (Australian Bureau of Statistics, 2007-08).
Older adults are among the most dependant on the health care system with some of the lowest levels of health literacy. This is due to a number of barriers including, education and literacy training, the technicality and complexity of health information, and the natural ageing process (Centre for Disease Control and Prevention, 2011). The National Assessment of Adult Literacy (NAAL) found that 80% of older adults had difficulty using documents, such as, forms or charts (NAAL, 2006). Poor health literacy in the older adult population can seriously interfere with the day-to-day care of chronic illnesses, such as, ischemic heart disease, which is the leading chronic illness and cause of death in the Australian older adult population (Australian Institute of Health and Welfare, 2008).
Ischemic heart disease (IHD), or coronary heart disease, is the most common form of heart disease and cause of heart attacks (Mount Sinai Hospital, 2014). IHD is caused by plaque build-up on the walls of coronary arteries, narrowing them and restricting blood flow to the heart (Dorling, 2009). In Australia, approximately 10,000 people die from heart disease each year (Australian Bureau of Statistics, 2007-08). IHD is a generally preventable disease. There is no single cause of IHD, there is however, numerous contributing factors that increase the risk of developing the disease (Heart Foundation, 2011). The first step, and perhaps the most fundamental, in preventing IHD in older adults, is educating individuals on the risk factors relevant to them.
The Australian Heart Foundation (2011) provides a list of two varieties of risk factors, modifiable and non-modifiable. Non-modifiable risk factors include; age, ethnic background, family history of heart disease. The modifiable (preventable) risk factors include; smoking, high cholesterol, high blood pressure, diabetes, sedentary lifestyle, obesity and lack of social support/social isolation (Heart Foundation, 2011). Health literacy is crucial in the management of IHD, as aforementioned, the majority of contributing risk factors are dependent on the lifestyle choices of the individual, meaning that with the right motivation and knowledge, the disease can, for the most part, be prevented.
Improving health literacy is the responsibility of the individual, the community, the government, and the health professional. The health professional has a direct and significant role in improving health literacy as they are the primary source for information, education and have the greatest level of patient contact. During interviews with older adults conducted in a study by the Department of Health and Ageing (2012), it was found that post hospitalisation patients were largely left confused with only their own resources to cope with the challenges of their condition. The patient needs to be provided with the resources, education and support necessary to provide a foundation for building health literacy, leading to better self-management and improved patient outcomes (Department of Health and Ageing, 2012).
Supporting development of behaviour change, implementing a patient-centred approach, providing patients with positive reinforcement and creating an environment that allows for progression and constructive change, are among the responsibilities of the health professional (Institute of Medicine, 2004). The patients’ responsibilities are to engage in treatment plans, follow self-management instructions and cooperate with health professionals in the best interest of their health and wellbeing (Nutbeam, 2000).
Improving communication is fundamental to increasing health literacy. Health professionals can improve communication by using methods, such as, the talk back technique, which is when the health professional asks the patient to repeat the information provided, back to the health professional, demonstrating their understanding (Stein-Parbury, 2013). Using various physical materials to visualise information, such as, charts, graphs, and instructions, is another useful method to improving communication of information and increasing the patients’ level of understanding (Stein-Parbury, 2013). Using effective communication methods and techniques, the health professional can empower the patient to access the necessary resources and become active in managing their own health needs (Nutbeam, 2000). This is exceedingly important in the management of IHD, as patient decisions are crucial in reducing the risk factors contributing to the disease.
In conclusion, health literacy is fundamental to providing effective health care. Patients, health professionals, communities and governments all play an important role in health literacy, whether it be empowering patients or funding educational programs. A rising quantity of evidence supports the importance of communication in professional health care. Some groups are predisposed by social determinants to have poor health literacy levels, such as the elderly. Elderly patients suffer greatly from preventable illnesses, such as, ischemic heart disease. It is therefore, understandable that it is necessary to provide comprehensive education and focus resources on improving health literacy in all communities.
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