The level of health literacy in a local population has implications for individuals, local people, health professionals, services and health economies.
Implications for individuals:
Research shows that people with low health literacy have poorer health status and self-reported health; have difficulty managing their own health and wellbeing, that of their children and of anyone else they care for; wait until they are sicker before going to the doctor; and are generally 1.5 to 3 times more likely to experience a given poor outcome. At the same time recent research has also shown that in England on average 61% of the adult working age population are unable to fully read, understand, and act on health information in common circulation. Whilst work to improve the health literacy of individuals and communities can help to address these issues in the longer term, it is also the responsibility of the healthcare system working in partnership with local community and third sector organisations, to provide the support people with different skills and abilities need.
“Health Literacy matters to me as a patient, because it means I am given the support I need to understand information that I am given, play an active role in my own health and care, working in partnership with my health care professionals, and get the right care and support when I need it”
Implications for health professionals’ individual practice:
Research shows that people with low health literacy are less able to communicate with healthcare professionals and take part in decisions. They find it harder to understand labelling and take medication as directed. Furthermore, people who ordinarily have adequate health literacy may have difficulty processing and using information when they are ill, frightened, or otherwise impaired.
At the same time, there is research indicating that healthcare professionals often use medical jargon, deliver too much information at one time, and do not confirm patients' understanding of what was discussed. Research also shows that doctors commonly overestimate patients' literacy levels, and rarely consider limited literacy skills in their assessment of whether patients understand what they need to do.
This means that there is a real need for health professionals to be trained in the skills they need to communicate effectively, such as using teach back, which will benefit all patients and people with low health literacy in particular. Read more about how health professionals can adapt their practice.
“Health literacy matters to me as a health care professional because it means I have the resources, skills and support to have better conversations with my patients and their carers about their healthcare. Both the patient and I have more confidence that we have reached a mutually agreed decision and a shared understanding of the plan and actions we are each going to take.”
Implications for services:
Research shows that people with low health literacy find it harder to access appropriate services, and have higher rates of avoidable emergency admissions. However, high quality, person-centred care can only be achieved if people can understand information or access and use services to support their health.
Services therefore need to be designed to accommodate people with a range of health literacy skills and to work in a way that enables people to access and benefit optimally from the services they provide. Research has shown that this approach can help everyone, not only those with low health literacy. Read more about how services and organisations can respond to health literacy challenges.
“Health literacy matters to me as a service manager as it means people are able to access the right service for them when they need it and get the support they need to be involved in their own health and care, leading to better outcomes.”
Implications for public health:
Research shows that people with low health literacy have more unhealthy behaviours (such as poor diet and smoking) and fewer healthy behaviours (such as good diet) than people with higher health literacy. They are also less likely to engage with health promotional activities such as influenza vaccination and breast screening. Health Literacy: the solid facts published by the World Health Organization sets out how health literacy is a key determinant of health and in non-communicable diseases in particular, as well as describing some approaches known to be effective in addressing this.
“Health literacy matters to me as a public health professional because it means greater uptake of health promotional activities, like flu jabs, screenings, and we are better at getting our messages out to people so that communities can improve their own health”
Implications for commissioners:
Research shows that people with low health literacy have poorer health status and are generally more likely to experience a poor health outcome. Health literacy is a social determinant of health and is strongly linked with other social determinants such as poverty, unemployment and membership of a minority ethnic group. As such it is contributory to health inequality.
Furthermore research in Canada and the United States has shown that limited health literacy is associated with high health system costs. However, health literacy differs from other social factors in that it is potentially open to change through improving the knowledge and skills of individuals and the wider community and improving health systems, services and professional practice.
Whilst there is currently little evidence or commentary in published literature about how health literacy issues should inform commissioning, we believe that considering health literacy in the commissioning process can support commissioning objectives related to improving overall population health, improving health outcomes and reducing health inequalities.
Commissioners therefore need to ensure that people with low health literacy have a voice and can influence the design of services to meet their needs, and that they use commissioning to develop health literate services.
“Health literacy matters to me as a commissioner because if we can create our services and local systems in the right way, we can provide services that are accessible to people who need them when they need them, tailored to their needs, leading to better health outcomes and reducing health inequalities, so maximizing the use of resources and achieving best value for money.”