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Health literacy is a new idea in New Zealand and this module has information about what health literacy is and what you can do about it.

How do we define health literacy? Health literacy is the degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisions (Korero Marama, 2010).

More than 1,620,000 adult New Zealanders have low levels of health literacy.

Special Guest Presentation: Susan Reid – So you are more likely to have low health literacy if you are male, if you’re older, if you’re Māori or Pasifika, if you live in a rural community, if you have English as your second language, if you’re unemployed or you have a low or no qualifications. Health Literacy about both the system and the individual so for individuals and whānau it’s about what they know about the topics, health topics they are interested in, what the causes of disease, what are the treatments they need to access and then the other important factor is their cultural view of health and disease, how do they feel about that? That’s really important. There are three main parts to the health system that you have to take into account with health literacy. The first one is the health care professional talking to their patients. The second part is the actual demands of the systems themselves – how do patients access the system, how do they get access to treatment and care. And the third part is the actual health care situation. So how is the patient feeling, do they have physical or mental problems, are they stressed, is this something really unfamiliar for them or something they are much more familiar with? All those things will impact on their health literacy. End

Patients can find it difficult to understand medical advice and information, especially as oral communication is harder than reading. Listening is harder than reading because there is nothing for the person to refer back to, or ask someone else to explain later. Explaining the most important information first, followed by the rest in small chunks will help.

The health system needs to take account of a person’s health literacy – not the other way around. We need make determined and considered efforts to reduce health literacy demands of the system and as our health care systems evolve we are adding more and more elements of self-management of chronic diseases. This means we put more demands on individuals and whānau, because they have to manage their own conditions, relying on many sources of information.

Special Guest Presentation: Susan Reid – The health care system is more complex these days and there is more responsibility put on the individual to manage their own care. So that means that an individual’s health literacy skills are needed so that they can navigate the system, that they can get a range of information, that they can manage medications and those medications can increase, that they are able to manage their own care and the care of their whānau as well. End

Of course make sure that you don’t assume that people will understand just because they are white and well dressed, or won’t understand just because they are brown and wearing casual clothes. Assumptions like this don’t help, and it is especially important because being a patient can be an unsettling experience or just plain foreign.

For example here is someone young, successful and well educated who still had problems understanding health information because of her situation. In 2009 Miriama Kamo, presenter of 20/20 and One News had an operation. Groggy after laparoscopic surgery, Miriama was in for a shock. “We managed to save your ovary,” she heard her specialist say. “I’m still horrified when I think about that,” she said. “I don’t know if it’s because I didn’t read the paperwork properly, but nobody suggested I might lose an ovary.”

We know that every health practitioner is highly motivated to make sure that their patient understands about their health. But we also know that doesn’t happen 100% of the time for all sorts of reasons.

Special Guest Presentation – Susan Reid – There’s good news we can do lots of things to reduce the demands of the system and everyone can be involved in that, and we can also be involved in developing the health literacy skills of our patients, and not just health practitioners and health professionals, but also the individuals themselves can take responsibility for developing their own skills. End

There are many things you can do. One thing is to encourage your patients to ask questions. A small change in how we invite patients to ask questions might be instead of asking people “Do you have any questions?” ask “What questions do you have?”

Instead of asking people “Do you understand?” I can ask them “Have I explained that clearly?” So instead of the question “Do you understand?” suggesting that the patient has the problem, we are giving the patient a chance to say we are not explaining something clearly enough, and give them the option to request further information or seek clarity.

Think about the language you use and think about who you are talking to. Do you have to use technical terms? Can you replace technical terms with everyday words? If you need to use technical terms explain them. It’s okay to use the words myocardial infarction if everyone is medically trained. Do you need to use the medical term or can you say heart attack? If you do need to use the word make sure you take the time to explain it along with other known associated names.

You can undertake a health literacy review of your clinical environment. This might begin by checking signs in your environment to make sure that they are not too hard to use for people to find their way around. Ask a group of patients to take a tour of your environment, and give them a list of places they need to find e.g. haematology, renal unit etc. Send someone with them to record what happens. Make sure they ask how they found out where to go. Did they ask someone, did they already know, what was confusing and why, what was helpful and why, what suggestions have they got? Use this information to change or add to your signs.

Improve your forms and documents: Review your forms and documents to make sure they are simple and clear for all to read. Test the new forms and documents with the people who will use them to get their feedback. Rewrite the form again taking the comments into account. Offer assistance with completing forms and making follow-up appointments. There are things you can do to change the forms and documents you use with patients.

Special Guest Presentation: Susan Reid – Health literacy is not just about plain English or re-writing documents so that they can be read by 11 year olds. Our patients aren’t 11 year olds, so health literacy one of the key things about re-writing documents and improving the health literacy is to involve the audience they’re written for in the re-writing of those documents. So if you are writing for Māori or Pacifica or older adults you need to get them involved and they’ll tell you what works for them. One of the most important things I’ve learnt from re-writing documents is that if you include a table or graph in that document you need to explain how that table or graph works. End

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