Adult Literacies ‘The Impact on Patient Care’

Aim To highlight the challenges of adult literacies in Scotland and explore the impact on patient care.

Learning Outcomes Describe how literacies issues can affect patients’ health Describe signs of literacies difficulties and the potential impact on healthcare Give 2 examples of possible changes to your working practice that reflect your increased awareness

Adult Literacies in Scotland 2020 Vision ‘By 2020 Scotland's society and economy will be stronger because more of its adults are able to read, write and use numbers effectively in order to handle information, communicate with others, express ideas and opinions, make decisions and solve problems as family members, workers, citizens and lifelong learners.’ [1]

National Consumer Council survey among 2,000 adults (2004) One in five people had problems with the basic skills needed to understand simple information that could lead to better health. Poorer sections of the community were less likely to seek information or help for health problems. [2]

Findings from The Scottish Survey of Adult Literacies (2009) 26.7 per cent may face occasional challenges and constrained opportunities. Within this, 3.6 per cent face serious challenges in their literacy practices. People who score lowest in all three categories are considerably more likely to be People from the 15% most deprived areas tend to have lower scores. [3]

What are ‘Literacies’?

Think Literacies Literacies Reading Number Skills Writing Speaking Listening Handling information Solving problems Expressing ideas & opinions

Did you know that in Scotland… 1 in 28 people of working age face serious literacies issues in their daily lives?

Literacies issues can have an impact on…  health and well-being  family life  financial capacity  employability and work

New Light on Adult Literacy and Numeracy in Scotland ( 2008) Poor physical and mental well-being is associated with poor literacy and/or numeracy Men with lower literacy levels who drank alcohol were also more likely to consume a higher number of units than those with good skills and they were more likely to smoke cigarettes. [4]

Literacies issues can make it difficult to…. Tell the time Read timetables Follow written and verbal instructions Complete forms Access information

Workshop Review the health information provided How can literacies issues in patients adversely impact care delivery?

The Scottish Government’s Health Literacy – A Scoping Study (2009) lists international evidence suggesting patients with low health literacy: Have less knowledge about health-promoting behaviours Are less likely to be aware and make use of prevention facilities Are less likely to adhere to prescribed courses of treatment Are less able to self manage Have poorer health status and poorer self-reported health Have poorer health outcomes including knowledge, intermediate disease markers, and measures of morbidity [5]

Self-management of long-term conditions Schillinger et al (2002) found: Diabetic retinopathy –36% of patients with low health literacy –19% of those with adequate skills. Optimal blood sugar control –20% of patients with low health literacy –33% of those with adequate skills. [6]

Self-management of long-term conditions Omachi et al (2011) Independent of race, income, and educational attainment, poor health literacy is associated with greater COPD severity and general health status... Attention to health literacy has the potential to improve COPD self-management. [7]

Weiss et al (2006) Randomised control trial with patients assigned either to: 1.An intervention group that received standard depression treatment plus literacy education. 2.Control group received standard depression treatment. Findings: Literacy skills improved and their depression severity lessened. Depression severity was lower in intervention group at final follow up at one year. [8]

Medicine and adherence Wolf et al (2007) found that 46% of patients misunderstood one or more dosage instructions. Patients with low literacy were less able to understand instructions compared to those with adequate literacy. [9]

Scenario 1 Scott is 19, he left school at 16 with 2 standard grades He was diagnosed with type 1 diabetes when he was 17 He appears to be dismissive of any information given and is impatient when talking to the pharmacist His diabetes is uncontrolled, resulting in him losing time from his workplace

Scenario 2 Margaret is 54 and has worked as a carer for 20 years. Margaret has SpLD She cares for a housebound 62 year old male with COPD requiring dental treatment Margaret is responsible for maintaining care plan and supporting medicine administration

What approaches are adopted in tackling the issue? Improve the literacy skills of the public/refer people to learning Improve the communications skills of healthcare staff e.g. - Let me show you - Tell me what you have been told so far - Talk me through what you will do at home - Would you like someone to go over that with you? - Teach back postcards

Better Health, Better Care: “There are lots of factors that contribute to bad health and early death. Poor housing, low access to good quality affordable food, lack of education and job opportunities, unreliable public transport, lack of local health services, lack of leisure facilities, excessive use of alcohol, taking drugs and smoking tobacco – all play their part.” [10]

Adult Literacies in Scotland 2020 Vision ‘By 2020 Scotland's society and economy will be stronger because more of its adults are able to read, write and use numbers effectively in order to handle information, communicate with others, express ideas and opinions, make decisions and solve problems as family members, workers, citizens and lifelong learners.’ [1]

Questions?

References [1] accessed 21 February [2] - Sihota, S. & Lennard, L. (2004) Health Literacy: being able to make the most of health. London: National Consumer Council. [3] accessed 21 February [4] accessed 21 February [5] accessed 21 February [6] - Schillinger et al Association of Health Literacy With Diabetes Outcomes. Association of Health Literacy With Diabetes Outcomes. Journal of the American Medical Association. Vol. 288:pp [7] - Omachi T, Sarkar U, Yelin EH, Blanc, PD, Katz PP Lower Health Literacy Among COPD Patients Is Associated With Poorer COPD Functional Outcomes And Greater Risk Of COPD-Related Emergency Utilization, paper in preparation, abstract shared in June [8] - Weiss BD, Francis L, Senf JH, Heist K, and Hargraves R Literacy Education as Treatment for Depression in Patients with Limited Literacy and Depression: A Randomized Controlled Trial, J Gen Intern Med. August; 21(8): 823–828. [9] - Wolf MS, Davis TC, Shrank W, Rapp DN, Bass PF, Connor UM, Clayman M, Parker RM To err is human: Patient misinterpretations of prescription drug label instructions, Patient Education and Counseling, 67, 293–300. [10] accessed 21 February