Person-centred prevention and care

Health literacy is served by person-centred prevention and care

In different healthcare settings it has been recommended to use person-centred approach to enhance health, quality of life and participation. Other related terms include patient-centred or family-centred care, and community-centred approaches. Person-centred care has found to be asssociated with improved self-management, patient satisfaction, adherence and improved health outcomes.

Person- or patient-centred prevention or care has been defined by the Institute of Medicine as: 

“providing prevention or care that is respectful of and responsive to preferences, needs, and values of individuals, and ensuring that values of individuals guide all decisions”.  

Person-centred prevention and care is based on a mutually beneficial partnership between providers, patients and their families in the design, implementation and evaluation of healthcare. Community-based approaches also facilitate collaborative partnerships and promote co-creation and empowerment with members of the community. Person, patient-, family- or community-centred healthcare applies to all ages and can be used in different settings.

More than interaction between patient and clinician

Patient- or person-centered communication is more than individual clinician-patient interactions. Health care organizations have a responsibility to facilitate patient-centered communication in all forms, including patient education materials, organizational signage, patient forms, and training providers to be better communicators.

Understanding the preferences, experiences and values of individuals and addressing their needs is important in complex health systems, which are characterised by overwhelming amounts of health information and different options for diagnosis and treatment.Patients with limited health literacy are considerably less likely to report receiving patient-centered communication from the organizations where they seek care, across an array of communication quality indicators.

So especially for people with limited health literacy, person-centred care will be beneficial. Addressing the preferences, barriers and needs of older adults with low health literacy is an important strategy to improve health.

Meeting the needs of people

According to clients, the main aspects of person-centred prevention or care are:

  • Respect for clients’ values, preferences and expressed needs;
  • Availability and accessibility of care;
  • Partnership;
  • Co-ordinated and integrated care;
  • Emotional support and alleviation of fear and anxiety;
  • Involvement of family and friends;
  • High quality information and education including counseling;
  • Continuity, including through care transitions.

The role of professionals and person-centred care

The health system is changing from a conventional hierarchically designed system to a more person-centred one. Professionals may be keen to take full control over the care of patients. This may be an attitude learned during education and the intention is to help the patient as much as possible. This can turn into patient-professional dependency. Patient-centred care doesn’t underestimate the role of professionals but puts the focus on the patient’s strengths and capabilities. As the patient has to live with the disease and its symptoms for years, deep dependency may not be preferable. A person-centred approach can be enhanced by capacity building of professionals and increased teamwork. Download PDF here

Nine core principles of person-centred care and useful practices to promote health literacy

Professionals or organisations that want to use person-centred care with the aim of improving health literacy can use different strategies. A ‘one-size-fits-all approach’ is not effective. The situation, experiences and expectations will all affect the preferences and needs of people with low health literacy. Important principles and useful practices are

1. Respecting each individual

Encourage open attitudes between the patient, the healthcare professional and the organisation. Open attitudes and treating all patients including older adults with respect and dignity help to build a trustful relationship, which benefit all

2. Honouring racial, ethnic, cultural, and socio-economic diversity and its effect on individual experiences and perceptions of care Download PDF here and here and Find website here

Taking into account the differences between people includes includes both an awareness of beliefs and norms that influence the behaviours and health of people. Providing the patient with health information in the language with which he or she is most comfortable is important. Or increasing the cultural competence of providers to make them sensitive to the needs of different groups in society for example people with low health literacy. Download PDF here

3. Recognising and building on the strengths of individuals or communities

It is recommended to identify and address individual health literacy issues such as facilitators and barriers for understanding, self-management and adherence. For example, people with limited health literacy did not fully accept risk messages regarding cardiometabolic risks for different reasons such as numerical information had ambiguous meaning, the purpose and setting of the risk assessment was unclear or they needed for more specific risk information. Download PDF here

4. Sharing reliable and honest information with individuals or communities in ways they find useful and affirming

Surveys show that people with low health literacy are often unable to understand information to self-manage their conditions. Professionals can ensure that the patients with limited health literacy understand health information by encouraging patients to ask questions. Another way is for the the professional to ask for feedback from the patient. Instead of asking “Do you have any questions?”, the professional could say: “I want to make sure that I explained things carefully. So, could you repeat the key messages we just discussed.”

The ‘teach-back’ method and motivational interviewing are both useful practices to accomplish patient-centered care. Within IROHLA we developed a health literacy training for professionals. One of the core elements is strengthening communication strategies of professionals that promote the development of interactive and critical health literacy among clients or patients.

With respect to written communication, individuals with low health literacy have specific circumstances and particular needs. Different strategies can be used to enhance the comprehensibility of texts:

  • Drawings and graphics can be used to express complicated medical messages.
  • Simpler terms can be used instead of medical jargon to improve the patient’s understanding.

Passive dissemination of health information – mass mailing and presentations for heterogenous groups – is largely ineffective.

5. Supporting shared decision making

Shared decision making has been defined as ‘an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences’.

Concrete actions to facilitate shared decision making include:

  • Investigating knowledge, preferences and barriers among clients;
  • Adequately informing clients to make informed choices;
  • Stimulating clients to read or search for additional information;
  • Making concrete plans of action with clients. Download PDF here

The ‘doctor-knows-best’ culture may not be beneficial. Building trustful relationship where the patients can express worries and doubts is beneficial for successful care.

6. Providing and ensuring formal and informal support (e.g. strengthening social networks) during the life course Find more information here

7. Collaborating with people at all levels in healthcare, e.g. in care provision, professional education, policy making, and programme development

Involvement of people with low health literacy can be improved to enhance the effects and relevance of policy and interventions within the health system. For example, people with low health literacy are frequently not included in the development and evaluation of e-health interventions.

8. Empowering people to discover their own strengths, build confidence, and make choices

Creating self-confidence in problem-solving capabilities is essential for users of preventive or curative services. It is important to identify and address individual health literacy issues, build compentencies and the motivation of patients.

9. Ensuring flexibility in organisational policies, procedures and provider practices so that services can be tailored to the needs, beliefs, and cultural values of people

Development of health literacy friendly environments has the potential to improve people’s quality of life, people’s experience of the healthcare system and patient safety. Healthcare settings supply information that people are expected to be able to understand and make use of. This information includes appointment letters, signs to get around the hospital, and information about treatment and care. Interventions have also been designed to assess whether healthcare settings promote health literacy, for example by focusing on whether they enable patients to actively manage their own health. Tools are available to assess and reduce environmental barriers to health literacy. Health literacy environmental interventions comprise multiple components such as: assessment of navigation, interpersonal communication, design of printed, audio visual and digital materials, and action planning and evaluation for optimal health service delivery.

Learning together to promote patient-centred care

In developing an evidence based health literacy training, groups of health professionals from Ireland, the Netherlands and Italy strongly endorsed a multi-disciplinary training. The reason given for the importance of this multi-disciplinary approach was that the patients journey through the healthcare system from primary care, to outpatient’s clinics to acute hospital care and back to the community meant that patients met many different health professionals in different settings at different points in time.  The health professionals considered that it was very important that all health professionals that patients come into contact with on this journey communicate effectively and that the interaction is patient focused and consistent.  Multi-disciplinary training is one way that this can be facilitated.

References:

IOM (Institute of Medicine) Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press; 2001.

Wynia MK., Osborn CY (2010). Health Literacy and Communication Quality in Health Care Organizations. J Health Commun. 2010; 15(Suppl 2): 102–115.
doi: 10.1080/10810730.2010.499981. Find PDF here

Mead N, Bower P. Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Education and Counseling. 2002;48(1):51–61.

Epstein RM, Street RL. NIH Publication No. 07-6225. National Cancer Institute; Bethesda, MD: 2007. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering.