1. Readiness How important is it for you to support patients experiencing difficulties with literacy or numeracy? How confident do you feel that you can offer support?

2. What is literacy? Literacy is now defined as: “the ability to read and write and use numeracy, to handle information, to express ideas and opinions, to make decisions and solve problems, as family members, workers, citizens and lifelong learners”.

3. Health literacy: “the cognitive and social skills and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” World Health Organisation (WHO) “literacy is the pathway between education and health”. Kickbusch (2004)

5. “My mother is very helpful…because when you get tablets or creams they’ve got instructions on the box, but also inside, they’ve got about what you can take with them…and so she reads a lot of that for me, which is useful, because I mean you don’t always do it. I mean at the moment I’m taking 18 tablets a day…she always does that. I tend to be a bit lazy.”

6. My skin was a mess. We had to fill in Disabled forms which was a nightmare. We got in touch with the DHSS, Bill got all the forms for Invalidity, Invalidity Care, Disability Allowance and Carer’s Allowance, Mobility Allowance and all that lot. Everything came in and they’re not forms. They’re hopeless. Absolute, absolute nightmare. They are unreal, and it’s like when we started filling in disabilities forms, oh, nightmare.

7. The Scottish Government estimate: approx. 14% are seen as having difficulties with literacy and numeracy. The evidence suggests a high proportion of these adults are to be found among: –people with health problems and disabilities –people who live in disadvantaged areas –workers in low skill jobs –people on low incomes –speakers of English as a second or additional language

8. Health inequalities Are less likely to be aware and make use of screening and prevention facilities. Are less likely to adhere to prescribed courses of treatment. Are less likely to know much about their chronic disease. Have poorer health status and poorer self-reported health. Are generally 1.5 to 3 times more likely to experience a given poor outcome.

9. Health inequalities 36% of those with poor literacy skills had diabetic retinopathy, compared to 19% of patients with better literacy skills. 20% of patients with literacy difficulties had optimal blood sugar control, compared with 33% of those with better literacy skills

10. Patient Safety 46% of patients with literacy issues misunderstood one or more dosage instructions. The rates of misunderstanding individual labels ranged from 8% for the instructions ‘‘Take one tablet by mouth once each day’’ to 33% for the instructions ‘‘Take one tablet by mouth twice daily for 7 days’’. Patients with low literacy were less able to understand instructions compared to those with adequate literacy

11. New Light findings Poor physical and mental well-being, together with poor health related practices, are associated with men and women with the poorest grasp of literacy or numeracy. More of these men and women had symptoms associated with depression They were more likely to smoke cigarettes every day, Men who drank alcohol were also more likely to consume a higher number of units than men with good literacy and numeracy skills.

12. Screen patient Ask: How often do you need to have someone help you with understanding forms, letters, or medicine labels? Does patient indicate “sometimes” or more often? Let patients know that many people have difficulty reading and understanding medical information. Ask: 1. Have you thought about getting help to build your confidence in skills like spelling, writing and using numbers? 2. Would you be interested in finding out more from the NHS Learning Advisor? Yes No Yes No evidence of literacy issue Consider whether additional support is required. NoRecord issue and ask referral questions on one more occasion e.g. at next appointment Contact Learning on Prescription Development Officer: Jacqueline Wray on 0141 232 0161

13. Self care Key words: ‘how much’, ‘how often’, ‘when’ and ‘how long’. Does patient understanding meaning of numbers? Use plain language. Limit the amount of information. Ask patients to repeat back your instructions. Encourage patient to ask questions. Provide basic written info Patients are better able to understand ‘‘Take one tablet in the morning and one at 5pm’’ compared with ‘‘Take two tablets by mouth twice daily’’ or ‘‘Take one teaspoonful by mouth three times daily’’. Contact Does person have DNA history? Accessing other services e.g. diabetes education? Is service suitable for patient with literacy or numeracy issues? Ask patient before referral if they have concerns. Clarify what support is available. Practice-based support for patients Explore all three options Discuss, agree and record best ways to contact patient and remind of appointments. YesNo Ask for alternative service or reduction in tasks

14. Readiness How important is it for you to support patients experiencing difficulties with literacy or numeracy? How confident do you feel that you can offer support?

15. “I never knew help was out there until I was asked… no one had ever asked me before” Woman aged 57, referred to Learning on Prescription