Improving Health Through Health Literacy for Older People

Low health literacy is not an individual problem. Engagement of multiple stakeholders can improve health, well-being and participation of older people with low health literacy.

What can policy makers do?

  • Recognise that low health literacy is one of the factors leading to health inequalities, and make it part of policies aimed at social inclusion.
  • Make health literacy part of all policies in healthcare, in patient safety programmes and healthy ageing strategies.
  • Create policies or interventions which support families and communities that assist older people with low health literacy in healthy living: for example, by giving caregivers networking opportunities to increase their level of health knowledge.
  • Create policies that enhance patient-centred care: healthcare workers must be aware and able to communicate effectively with older people with low health literacy, especially when clients face difficulties in understanding medical treatments.

What can organisations in the welfare, education or commercial sector do?

  • They can influence health literacy by improving reading and writing skills or assisting citizens with low literacy skills, by introducing computer skills or by creating access to understandable information.
  • Patients often respond well by interacting with others who have overcome similar problems. People with low health literacy can more easily share their concerns and identify with persons living in similar contexts and circumstances.
  • Community networks offer opportunities for sustainable improvement of self-management.

What can healthcare organisations do?

Policy makers, managers or professionals can facilitate changes in the organisation of the health system:

  • Improve access, for instance to health professionals, or even social services and the Internet to improve health literacy and health outcomes. Make services and health-related resources more accessible, so that (for instance) patients can more easily understand procedures, make appointments, or understand written or oral information. Better appointment systems, easily understandable signage and hostesses showing the way are simple measures to empower people. Increased self-efficacy stimulates people to take more responsibility for their own health.

Innovation: A library for patients in a hospital

An information Centre can enhance health literacy of patients, their relatives or people who support them. People can get information related to all aspects of care in different life stages: prevention, diagnosis, treatment or homecare. Medical facts are important but also psychological and social aspects of diseases are taken into account. For example communication materials will address the personal experiences of people with diseases. This information will support them in understanding health problems, decision making and self-management.

  • Facilitate training of health professionals in recognising low health literacy and improving communication. Make it part of continuing professional development and simulate peer group support to sustain new skills and attitudes. Find more information here
  • Institutions can review written information given to patients: information leaflets should be written simply and using direct language. Use of pictures and diagrams helps in the explanation of complicated issues. Written information given to patients needs to highlight that information most relevant to patient needs (Key Facts), such as likely prognosis and when to seek help.

What can health professionals do?

Recognising persons with low health literacy, understanding their needs and difficulties and developing actions can be challenging. Often people hide their problems because of stigma and shame. As a professional you may overestimate health literacy skills. Health professionals can mitigate the negative effects of low health literacy in different ways.

Maintain good communication

  • Person-centred communication is effective to encourage the patient to share his/her problem, preferences, needs and ask questions. This stimulates information exchange while engaging the person and building self-confidence (see also: link…).
  • It is often useful to ask patients to feedback their understanding of health issues and proposed therapy as they would to a friend, to identify any misunderstandings or gaps in their knowledge (the TeachBack method).
  • During consultations, health professionals can inform patients about good sources of information that they can access independently (such as reliable websites or community support groups)

Health messages for older persons are effective if they are frequent, repeated and packaged in multiple channels (such as oral presentation, leaflets, video, website references, etc). Routes of communication can be applied simultaneously: face-to-face, letters, leaflets, phone, or electronic media and methods of frequent follow up. Find more information here

Example
Ask-Me-3 encourages patients to ask, and physicians to answer. There are three basic questions during every medical encounter.
• What is my main problem?
• What do I need to do (about the problem)?
• Why is it important for me to do this?

E-health and m-health can assist in strengthening health literacy

Innovative e-health and m-health applications can be very useful. E-health for older people is successful when it is user-friendly (simple and accessible), useful (showing effect, inviting continued use), and sustainable (fitting in a health plan suitable for the user). These electronic applications are best used in combination with face-to-face interventions, telephone messaging, etc. Privacy and confidentiality are important concerns of older people. More information on e-health and m-health as part of the IROHLA project can be found here.

The Internet can serve as a source of information for health, if it is easy-to-read and reliable. Patients appreciate advice about which websites contain reliable, up-to-date and clear information. Governments should institute quality assurance for websites, so that people can recognise reliable sites.

Example
Tablets in homecare programmes provide easy communication with nurses, information on services, ordering of medicines, alerts on medicine intake, planning of care activities, etc.
They also facilitate social contacts with distant family and friends.

It is important to acknowledge that older adults in Europe are a diverse group, coping with different settings, cultures and contexts. Minority groups in Eastern Europe, migrants from other continents, people with low education in isolated rural areas all have their own characteristics. Therefore interventions need to be adapted to local needs and circumstances. For instance, informing people about local services (such as support groups or Internet access in public libraries) that can help patients manage their health issues, or where they can get ongoing information.

Tool

Tongue Communication Skills for Patient-centered Care, The Journal of Bone & Joint Surgery JBJS.org Volume 87-A Number 3 March 2005 Download PDF here