1. Learning is Good for your Health: how literacies link to health outcomes
Janet Weir
November 2015
Welcome - Introduce myself and role
Literacies work is very similar to Health improvement activity, it’s all about tackling inequality and promoting healthy lifestyles or at least a choice of lifestyles. Current research highlights that awareness of health literacy or the possibility (or not) of people having the knowledge, skills and confidence to be active partners in their own health care, is extremely important and that’s what this presentation is designed to raise awareness of.

2. After this training participants will be able to
• Describe how literacy and numeracy issues can effect patients health • Describe signs of literacy and numeracy difficulties and the potential impact on health care • Interpret the national statistics for your own area of practice • Discuss ways of broaching the subject of literacy and numeracy with patients/clients • Give examples of possible changes to your working practice that reflects your increased awareness • Identify available literacy and numeracy support mechanisms for patients/clients
A patients journey will include the receiving of a wide range of information, instruction and guidance in various forms from written, verbal, electronic, therefore health professionals need to be aware of whether the patient is able to understand what is being communicated. This session has been designed to help you
to …….. (read)
This session was mainly developed from the Government’s ‘Learning is Good for your Health’ guide (2012) (show)
However this has now been built upon to develop ‘Making it Easy’ a Health literacy Action plan for Scotland (2014) (show)

3. Making it Easy - June 2014
• Highlights the hidden problem of low health literacy and the impact that this has on our ability to access, understand, engage and participate in our health and social care. • Explains that low health literacy leads to poor health outcomes and widens health inequality. • Calls for all involved in health and social care to systematically address health literacy as a priority • Sets out an ambition for all in Scotland to have the confidence, knowledge, understanding and skills we need to live well, with any health condition we have. • Lays out the actions the Scottish Government and partners are taking to help health and social care collaborate to help realise this ambition.
Read then hand out quiz

4. Are CAPITAL letters easier to read?
How many of us when we’re trying to write clearly for people write in block capitals? Whereas if we look at the next slide…..

5. Aoccdrnig to rscheearch, it deosn't mttaer in waht oredr the ltteers in a wrod apepar, the olny iprmoetnt tihng is taht the frist and lsat ltteer be at the rghit pclae. The rset can be a toatl mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe.
Some research suggests that the above is the case in which case the ‘pictures’ that words make help us to ‘guess’ the words and block capitals don’t make it easier. However as with all things, other research says that competent readers can just read very fast!

6. 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.
In 2009 the university of glasgow & partners carried out a survey to identify the literacies skills levels of the 16 – 65 population. Over a quarter will have some issues. Although when you talk about literacy issues this could mean a variety of things from reading a timetable, or reading an official letter or newspaper, or knowing about numbers whether quantity or time. Few will have problems in all the areas, only 3.6%. Which is about 1 in 28 of the working age population Who really can’t take part in today’s society, can’t count change, read a destination on a bus or write own name and address.
Lowest category is 56 – 65 although most worrying is that the next lowest is the 16 – 25 age group, things aren’t getting better.
Probably not unexpectedly, people from the most deprived 15% of areas tend to have lower scores, and these also tend to link to, and be associated with health problems, receipt of benefits, lower incomes etc.
Evidence has remained constant over the past 2 decades that there are clear associations between low levels of literacy and poorer health (parsons & bynner 2008) (st clair et al 2010).
Just to give you an idea in Falkirk these numbers would be
Population in 2011 = 154,380
26.7% = 41,219 people in Falkirk area may face occasional challenges and constrained opportunities.
3.6% of these = 1,484 will have serious challenges
And as we move further on you’ll see that particularly in the health area things are even worse

7. 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.
Raising awareness is one part of the ALIS 2020 vision. Discuss problems getting people to attend literacies classes – most are ‘satisfied’ with their level of literacy, therefore must ensure that organisations that come into contact with people are aware there may be issues and have thiought of ways to support people as well as being able to direct them to dedicated classes if relevant. .

8. 2020 vision for Health & Social Care
Scotland’s 2020 Vision for Health and Social Care focuses on prevention, anticipation and supported self-management.
Addressing health literacy is at the heart of this commitment to delivering a safe, effective and person-centred healthcare system.
It is important therefore for health services and practitioners to support people to develop their knowledge, skills and confidence to be active partners in their care.
Similarly
E.g. when computers came out instead of upskilling people – they made computers easier so that even 3yr olds and below can use them! therefore our classes will only help a few it may well be that services have to adapt to ensure things are as easy as they can be

9. What do we expect people to do?
Think about your contact with patients and the general public. What do you expect them to read, write or calculate?
If they struggle with literacy or numeracy what effect might this have?
Small group work flip chart– feedback.
Real life examples
impact of literacies on health
Part 1 of video
Harvard walk through of service

10. 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.
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.
example of Chinese family who didn’t understand dosage – could have been lethal.
Question – in groups – what do you think would be the sign that someone was having difficulty with literacies?

11. Identifying if someone is having difficulty..
Morris, MacLean, Chew and Littenberg (2006): developed a single item screener: How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy? Possible responses are 1-Never, 2-Rarely, 3-Sometimes, 4-Often, and 5-Always. Scores greater than 2 were considered positive, indicating some difficulty with reading printed health related material. Morris N.S., Maclean C.D., Chew L.D. & Littenberg B “The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability”, BMC Family Practice, 7:21.
Hand out red flags – hospital & school etc
Play part 2 of video
Broaching the subject; how comfortable do you feel? This seems quite easy compared to some more personal questions other health professionals have to ask?

12. What approaches are adopted in tackling the issue?
Rudd:
Improve the literacy skills of the public/refer people to learning
Improve the communications skills of health care 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
Hand out talk back cards and
play part 3 of video
Hand out word sheets & Have a go at simplifying the words you may commonly use
Remind not to use colloquialisms either e.g. ‘have you passed water?” (ESOL)

13. What else?
Signposting – posters etc

14. “ I never knew help was out there until I was asked… no one had ever asked me before”
Woman aged 57,
referred to adult literacy learning through
Keep Well programme

15. or 01324 504450 to speak to Janet, Angela or Ann
or to speak to Janet, Angela or Ann