How to make health- and social services accessible

Accessibility of health- and social services has different aspects

Accessible health and social services enable people to use appropriate healthcare resources in order to maintain or improve their health. The question of accessibility relates to different aspects, such as access to buildings, communication with healthcare staff, management of appointments and explanation of medication. Health systems have to be accessible in order to include all parts of the population in health and social services.

The accessibility of healthcare services results from an interaction between different factors, including health systems coverage, depth of coverage, affordability, and the availability of healthcare services. Organization and management models used in a health system also have an impact on accessibility. Accessibility may be low if health systems are too complex and lack transparency.

Access to healthcare is only possible if there is an adequate supply of healthcare services available. This is measured, for instance, by looking at the number of doctors or hospital beds per capita. However, service availability does not necessarily imply that access will be realized. It is therefore important to focus on the actual utilization of services and potential barriers to access.

Which barriers limit access to services?

In order to better understand the concept of access it is helpful to consider the different kinds of barriers that limit the utilisation of services.

  • Personal barriers: Utilisation of services is influenced by people’s recognition of their needs for services and their attitudes towards the health system. These individual perceptions can present a barrier to access, e.g. if people had previous bad experiences with health services.
  • Financial barriers: Even in a health system that is essentially free at the point of use, there can be charges for specific services like eye tests or dental check-ups, which can limit access for some people. Moreover, there may be additional costs, such as those related to travel to a clinic or time lost from work.
  • Organisational barriers: These barriers can result from a failure to design services according to peoples’ needs or from an inefficient use of existing capacities. They can, for instance, lead to long waiting lists or waiting times.

These barriers can affect some groups of people more than others. Thus, it is essential to address these barriers and to improve equity in the utilisation of services.

Why are health literate healthcare organisations important?

There is often a mismatch between people’s health literacy skills and aptitudes and the health literacy demands placed upon them. This can have a negative impact on people’s health. In order to improve health literacy, it is important to make access to health and social services easier. This includes use of the internet, computer literacy or access to transport.

Health literate healthcare organisations make it easier for people to navigate, understand, and use information and services to take care of their health. This is beneficial not only for people with limited health literacy, but also for all people who find it difficult to understand and use currently available health information and health services.

Brach et al. (2012) defined ten attributes of health literate healthcare organisations as follows:

  1. Has leadership that makes health literacy integral to its mission, structure, and operations.
  2. Integrates health literacy into planning, evaluation, 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 stigmatisation.
  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, audio-visual and social media content that is easy to understand and act upon.
  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.

Healthcare organizations that adopt most of the aspects in even a modest way will be able to better respond to individuals’ needs, especially those of people with low health literacy. In this way, they make it easier for patients to navigate through the system and contribute to improved population health.

How to measure if healthcare services are health literacy friendly?

In the context of the provision of healthcare, a number of audit tools have been developed in various European countries to systematically assess the health literacy demands of health service provision. These often relate to hospital environments. The tools generally include an audit of signage for navigation through hospital environments and assessment of written materials. The aim of these tools is to determine if healthcare organisations such as hospitals offer environments that support health literacy best practices and match the needs of service users.

Within IROHLA, a group of researchers evaluated health literacy friendly organisation tools. More information can be found here.

How to make health and social services health literate: a roadmap

The purpose of the Roadmap for Hospitals is to inspire hospitals to integrate concepts from the communication, cultural competence, and patient- and family-centered care fields into their organizations. Recommended issues to address, example practices, and “how to” information are included to help hospitals meet their patients’ unique needs. Download PDF here A hospital must embed effective communication, cultural competence, and patient- and family-centered care practices into the core activities of its system of care delivery—not considering them stand-alone initiatives—to truly meet the needs of the patients, families, and communities served. The recommendations in the Roadmap for Hospitals do not encompass every aspect of these three areas, but they do represent key issues that hospitals should consider to meet the unique needs of each patient.

References

  • Brach C et al. (2012) Ten Attributes of Health Literate Health Care Organizations. Download PDF here
  • DeWalt DA, Callahan LF, Hawk VH, Broucksou KA, Hink A, Rudd R, Brach C. (2010) Health Literacy Universal Precautions Toolkit. (Prepared by North Carolina Network Consor­tium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF) Rockville, MD. Agency for Healthcare Research and Quality.
  • European Commission (2014). Communication from the Commission on effective, accessible and resilient health systems. Download PDF here
  • Gulliford, M et al. (2002) What does ‘access to healthcare’ mean? Journal of Health Services Research & Policy Vol 7 No 3.  Find website here
  • Rudd, RE. & Anderson, JE. (2006) The health literacy environment of hospitals and health centers. Partners for action: making your healthcare facility literacy-friendly. The National Center for the Study of Adult Learning and Literacy.
  • Weiss, Barry D. (2007) Health literacy and patient safety: Help patients understand: manual for clinicians. Download PDF here
  • The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010. Download PDF here