Health Literacy “Health literacy is about people having the knowledge, skills, understanding and confidence they need to be able to use health and care information and services.” (NHS England 2018) Ask participants to define Health literacy Point out that although we all need to be health literate to keep well and to manage illnesses/conditions, most people will struggle with health literacy at some point. Patients may find themselves in new surroundings, new people, unfamiliar settings. New language, use of technical terms and jargon – vulnerable sometimes dependant, frightened people – HC environment -alien context for most people Health Literacy – is not all about people’s literacy skills – but people with low or poor literacy skills will struggle even more. Compare this term to computer literacy – we all appreciate that often, regardless of how literate someone is, it’s not a given that they will be computer literate – different skill Health literacy is the skill of understanding and navigating health care contexts 1

Findings from various surveys Health information in current circulation is written at too complex a level for 43% of working age adults (16-65 years); this figure rises to 61% if the health information includes numeracy. (healthliteracy.org.uk 2018) NB* Regardless of literacy levels most people will struggle with health literacy, those with low or poor literacy levels will struggle even more!!!! 2

Public health nurse: “Jill, I see you are taking birth control pills Public health nurse: “Jill, I see you are taking birth control pills. Tell me how you are taking them.” Jill: “Well, some days I take three; some days I don't take any. On weekends I usually take more.” Public health nurse: “How did your doctor tell you to take them?” Jill: “He said these pills were to keep me from getting pregnant when I have sex, so I take them anytime I have sex.” This story is true. Jill is a single woman, age 21 years (Consult 2008)

Low Health literacy: not just a problem for patients with limited education or reading ability - can also be found in individuals who may be highly literate in other areas but have difficulty understanding medical terminology and jargon. https://www.youtube.com/watch?v=bDHEEV0M62Y Patients may be embarrassed to admit their lack of understanding and sometimes matters can be further complicated by anxiety or confusion associated with pain or drug treatments. The use of Teach Back will ensure that patients understand what is being explained to them.

The Scale of Limited Health Literacy 42% working age individuals – unable to understand & make use of everyday health information 61% find health materials too complex to understand 43% - unable to calculate childhood Paracetamol dose (Public Health England, 2015)

People with Low Health Literacy: 1.5 - 3 times more likely to experience increased hospitalisation or death More likely to have depression More likely to struggle with managing their and their family’s health and wellbeing Increased risk of developing multiple health problems Use fewer preventive and health promotion services, such as cancer screening and flu vaccinations Have less recall and adherence to medical instructions and healthcare regimes Find it more difficult to access appropriate health services Make more use of accident and emergency services and have longer in-patient stays Have less effective communication with health and social care practitioners Less likely to engage in active discussions about their health options, potentially leading to their health needs being hidden (Public Health England, 2015)

Improving Health Literacy Increases health knowledge Builds resilience Encourages positive lifestyle change Empowers people to manage long-term health conditions Reduces the burden on health and social care services

This website is the main source of health literacy information and resources in Scotland http://www.healthliteracyplace.org.uk/

Teach-Back The use of Teach Back will help ensure that patients understand what is being explained to them. A way to confirm that you have explained to the patient what they need to know in a manner that the patient understands 9

Teach-Back Not a test of the patient’s knowledge A test of how well you have explained the concept Should be used by everyone with everyone Avoids use of ‘closed’ questions Takes time to learn, requires practice Can save time in the long run Person centred approach Can improve patient safety and patient outcomes 10

Asking patients to demonstrate understanding using their own words: Teach-Back Asking patients to demonstrate understanding using their own words: “I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?” “What will you tell your husband about the changes we made to your blood pressure medicines today?” “We’ve gone over a lot of information about your diabetes tablets, In your own words, can you tell me what we talked about?” Get used to using teach-back for every interaction with patients/carers/relatives 12

Teach-back… Creates an opportunity for dialogue in which the provider gives information, then asks the patient to respond and confirm understanding before adding any new information Re-phrase if a patient is not able to repeat the information accurately Ask the patient to teach back the information again, using their own words, until you are comfortable they really understand it If they still do not understand, consider other strategies .