Health Literacy: Read All about It …

Abstract

One of the key goals in the personalised medicine era is to improve communication between front-line healthcare professionals and their patients. The latter should have an equal role in any decisions made about their treatment, and this requires them to be able to input vital information, such as lifestyle and work circumstances, as well as to be properly informed from the other side. Discussions should be a two-way street. To help facilitate this, it is more important than ever to bring Europe together in a way that improves the already significant skills that healthcare professionals possess to permit co-decision-making which will effectively empower the patient. Clearly, the healthcare professional is trained to be an expert in diagnosing conditions and suggesting treatments. And yet the patient also knows more about his or her own lifestyle, work environment and how much he can rely on family-care resources, for example, so co-decision is a growing part of modern-day medicine. Ultimately, the two must work together to produce the optimal result.

Two-Way Decisions and Health Literacy

Who knows best, the physician or the patient?

The first reaction for many would be “the physician,” of course, but the times are changing quickly and, nowadays, it depends on many factors [1].

Clearly the healthcare professional is trained to be an expert in diagnosing conditions and suggesting treatments. And yet the patient also knows more about his or her own lifestyle, work environment and how much he can rely on family-care resources, for example, so co-decision is a growing part of modern-day medicine [2].

However, this co-decision can only work if both “sides” have a good degree of health literacy.

As personalised, patient-centric medicine moves on apace, there is an issue here that means that even the best doctors need to keep up with new treatments.

Training for Healthcare Professionals

New ways of treating patients are largely based on specific concepts or biological pathways in a field which is continuously moving. And this means that all healthcare professionals in close contact with patients (and/or their families) need to possess a solid knowledge of the current aspects of medicine and its latest breakthroughs [3].

Continuous training is necessary to give the right treatment to the right patient at the right time and there is not enough of it going on [4].

As an unwanted backdrop, there is an undeniable reluctance among some doctors and nurses to embrace new technologies and move on to modern, more targeted medicines and treatments, perhaps based on a difficult topic such as a patient's genetic profile.

As alluded to, fast-moving science, while offering great opportunities, undoubtedly makes life in the surgery and beyond more complicated. And no matter how good the healthcare professional is, it is difficult to keep up to speed on all developments [5].

On the other hand, patients are growing more and more knowledgable about their conditions (albeit often through the internet, which of course can pose its own problems in respect of misinformation).

What is key, or should be, is communication between the two, based on knowledge or literacy.

Benefits of Health Literacy

This can cover many areas. Within the medical profession there is often a lack of understanding between different silos, which is understandable given the different areas of expertise. This also extends to different stakeholder groups, even before we consider the patient [6].

Meanwhile, the patient may struggle under the weight of extra knowledge, although avoiding old-style patronising of him or her is key to a solid, modern relationship.

Health literacy has been proven to save money in healthcare budgets, and the World Health Organization (WHO), among others, has called for policy action to strengthen it.

Evidence has been shown that strengthening health literacy builds individual and community resilience, helps to address health inequities and improves health and well-being [7].

In Europe, health literacy (among patients) is a key part of Health 2020, the European health policy framework which was adopted by Member States in 2012 [8].

It can extend to lifestyle choices, such as “to smoke or not to smoke,” alcohol-drinking levels and exercise regimes to fight obesity. Many campaigns attempt to focus on patient education, but the support networks for patients trying to follow one path or another are not always satisfactory [9].

Indeed, a European Health Literacy Survey found that nearly 50% of adults tested in eight European countries have inadequate or problematic skills “that adversely affect their health literacy” [10].

This tends to lead to the individual making less healthy choices, indulging in riskier behaviour, and, in patients already diagnosed with a disease, brings about poor self-management of chronic diseases, lower adherence to medicine regimes (perhaps through poor explanations by the clinician and too complex instructions on medicine bottles), and, inevitably, more time spent in hospitals and doctors' waiting rooms.

This obviously leads to further draining of resources in already stretched healthcare systems.

Literacy as Social Capital

On top of this, as a WHO report points out, health literacy is an important form of social capital, it being an asset for individuals and communities. High literacy rates benefit societies, with the more literate individuals participating actively in economic prosperity. For the benefit of all, it clearly needs to be better promoted.

Such health promotion has been described as “the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment.”

Worthy goals, of course, but difficult to achieve across all countries and socio-economic groups. But Europe must strive to do so, as some 350 million working days are lost in the EU every year, which is bound to grow higher as the number of workers over 65 years old continues to grow rapidly. There is therefore obviously a strong case for businesses to invest in health literacy [8].

Communication Is King

Despite the fact that, as already mentioned above, patients are more informed than ever before, all is still not rosy in the garden. In fact, health information is often inaccessible because, says the WHO, “the literacy demands of health systems and the literacy skills of average adults are mismatched.”

And what about so-called eHealth literacy? The latter is defined as “the ability to seek, find, understand and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. [It] combines six core skills, namely: traditional literacy, health literacy, information literacy, scientific literacy, media literacy and computer literacy” [11].

That's a lot of “literacy” for anyone to handle.

In the end, at the core of the ideal, the modern relationship between healthcare providers and their patients is increased communication to facilitate co-decision-making.

Not only should professionals be trained to interact much better with relatively health-literate patients, but they should also be trained to do so, perhaps more importantly, with those who have little or no health literacy.

It's a two-way street, or should be, in a one-on-one relationship. But let us not forget that politicians, the media, civil society and employers can all play a part in addressing the challenges of health literacy.

There is a role for all stakeholders, literally…

Disclosure Statement

The authors have no conflicts of interest to declare.

Funding Sources

No funding sources.