Health Literacy in Athens, Greece: Exploring Sources of Health Information in Adults

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Health Literacy in Athens, Greece Exploring
Sources of Health Information in Adults
Barbara Kondilis MSW, MPH , Patrick D. Akrivos,
M.A., Sandy Salloum, BBA, Matthew E.
Falagas,MD, MSc, DSc

• EHMA Annual Conference
• June  25-27, 2008 - Athens, Greece

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Literacy

• The persons ability to read, write and speak a
  language, in addition to solve problems at a
  level that allows functioning at work and in
  society, as well as achieving goals and
  developing potential and knowledge

Bouchard, 2007
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Health Literacy

The degree of the persons ability to obtain,
process and understand basic health information
and utilize services required to make appropriate
health decisions
Bouchard,2007Kirksey et al., 2004 Mayer et
al., 2004Gazamararian et al., 2005
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What is health literacy? (simply)

• Health literacy is the ability to read (access),
  understand,and act on health information.

Definition The Center for Health Care Strategies
Inc., 2000
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Health, composed of a sound mind and sound body
was the foundation of the ancient Greek ideal of
life
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• Education and high levels of literacy is
  essential in any societys economy and
  development and acts as a determinant of health.
• People with low literacy levels are more likely
  to have poorer health.

Parker et al., 2003 Nutbeam et al., 2000
Lindau, et al., 2002
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• Greece has never conducted in-depth studies on
  functional adult literacy similar to the National
  Assessment of Adult Literacy (NAAL) or the
  National Adult Literacy Survey (NALS) conducted
  in the United States through the U.S. Department
  of Educations National Center for Education
  Statistics.

More info on U.S. Adult literacy U.S. Department
of Education, National Center for Education
Statistics http//nces.ed.gov/naal/
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Our studys focus

• The exploration of the sources of health
  information with particular focus on the use of
  pamphlets
• The reasons for the patients medical visit to
  the doctor
• Frequency of doctor visits within the last six
  months
• Patient and health-care provider communication

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Methodology

• A self-report type questionnaire was developed
• (consisting of 46 questions divided into five
  sections)
• Personal demographics,
• Reasons for visiting the hospital or the
  physicians office
• Sources of health information
• The use of pamphlets as a source of health
  information
• Patients communication with the
  physician/medical staff

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• The questionnaire was distributed in the period
  from Spring until Winter of 2007 through four
  channels in Athens (Attica)
• A private hospital
• A private university
• Private physicians practice
• A convenience sample from other sources

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N 105
Regions Attica (Athens area) 79 (83) Other 15
(16) Missing info 6 (6)
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N 105 44 males 61 females
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Doctor visit Frequency Reasons

• Last 6 months Doc Visit
• 3 or more times 31 (32)
• 1-2 times 39 (41)
• No Other time 27 (28)
• Missing 4 (4)

Missing
64 visiting a General Practitioner (Pathologos)
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Top three health issues that patients asked their
health care providers about in the last 6 months

1. Nutrition (61)
2. Oral health (49.5)
3. Physical activity (32)

23 respectively also asked about STDs and Smoking
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Knowledge of the Public Health System
50-50! About half of the respondents feel they
have a good or acceptable knowledge other
half feel they have poor or very poor
knowledge
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Sources of Health Information
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Internet use

• Greeks on the whole do not use the internet as
  OECD data shows that less than 40 of Greek
  population uses the internet.

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LISTED SOURCES OF ADDITIONAL INFORMATION

Frequency Percent
20 Responses Family Friends 1 1
20 Responses Friends other Physicians 1 1
20 Responses Internet 4 4
20 Responses Internet family 2 2
20 Responses Other 2 2
20 Responses Other Physician 5 5
20 Responses Other Physician Family 1 1
20 Responses Pharmacist 9 9
20 Responses Pharmacist Family 2 2
20 Responses BLANK 73 73
Total 105 100.0
General Survey Comments (not all inclusive) I
use doctors to get information but talk to my
friends to gain from their experience My
responses to this survey only relate to Dr. X
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Women
Women Women InfoPharm InfoTV InfoMag InfoDoc InfoNet InfoFamily Infofriends InfoPamphlets
N Valid Respns 52 (55) 56 (59) 52 (55) 53 (56) 50.5 (53) 50.5 (53) 51 (54) 49 (51)
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Men
Men Men InfoPharm InfoTV InfoMag InfoDoc InfoNet InfoFamily Infofriends InfoPamphlets
N Valid Respns 38 (40) 40 (42) 38 (40) 47 (39) 49.5 (39) 37 (39) 40 (42) 36 (38)
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Health Info from Doctor
Likert Scale Men (39) Women (56)
Not at all 3 (1) 2 (1)
Rarely 5 (2) 13 (7)
Sometimes 44 (17) 23 (13)
Often 26 (10) 29 (16)
Always 23 (9) 34 (19)
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Info from Pamphlets
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Client- healthcare provider communication
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Communication with Doctor Medical Personnel

• ? for Patient - Doctor Communication
• 76 (80) often or always feel
  comfortable talking to their doctor
• 78 (82) have all their questions
  answered
• 72 (76) understand all info given
• 69 (72) feel doctor spends enough
  time explaining issues
• 73 (77) feel doctor supports and
  understands them
• ? for Patients feeling supported by other staff
• Staff offers health information 29.5 (31)
  always or often 20 (21) sometimes
• 25 (26) rarely
• Staff is supportive 40 (42) always or
  often 25 (26) sometimes 17 (18) rarely

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90.5 of the sample, indicate they often to
always follow their doctors orders

• 56 of the sample, rarely
• to not at all ask for additional information
  from their physician

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Correlations
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Correlations by Education level
InfoTV InfoMag InfoDoc InfoNet InfoFamily Infofriends InfoPamphlets
Education Spearman's rho -.208() .087 .138 .347() .013 .015 .145
Sig. (2-tailed) .040 .410 .189 .001 .901 .885 .183
N 98 92 92 89 89 93 86
Correlation is significant at the 0.05
level Correlation is significant at the 0.01
level
PublicHealthSystem Knowledge
Education Spearman's rho .263()
Education Sig. (2-tailed) .009
Education N 97
Correlation is significant at the 0.01 level
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• Patients who followed their physicians
  directions regarding medication were also more
  likely to ask for additional information from
  their physician
• ? Pearson correlation significance 0.447 (at the
  .001 level).

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Discussion
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Sources of Health Information
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No primary source of health information could be
identified as pertaining to this sample of adults
in Athens.
It can be deduced that the sampled population
takes in health information from a multitude of
sources, but whether this actually contributes to
a raised level of health literacy has yet to be
determined.
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When planning health campaigns, a balance among
various information outlets should be utilized
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Patient Health care provider communication
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• Data shows that the client -healthcare provider
  relationship is satisfying in our sample overall,
  as participants feel comfortable and understood
  by their physicians.

3 patients mentioned on their surveys that the
information concerning client physician
communication only refers to their physician and
does not refer to their experiences with other
physicians.
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Pamphlets

• Pamphlets do not seem to be a major source of
  health information though about half of the
  respondents stated that they are able to acquire
  pamphlets if needed.
• Readers of pamphlets may further not be educated
  on advanced or even basic medical terms used
  (readability/health literacy) in the pamphlets,
  thereby rendering them of little use.

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In context

• In Greece, pamphlets are often created by
• health or research institutions
• pharmaceutical companies
• public health organizations
• though their level of readability in the context
  of the publics health literacy is questionable.

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Limitations
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• The study is cross-sectional in design and thus
  is not predictive in nature.
• The generalizability of study findings may be
  limited due to the selection method of the study
  population and the limited sample size.
• There is no formal way of measuring health
  literacy levels in adults existing in Greece that
  could be utilized for this study.

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• Patients will need better information if they
  are going to improve their lifestyle, manage
  their disease, and participate in complex
  decisions about treatment.
• Better health-literacy education in schools
• Better-written health materials
• Well-trained educators for patients.
• a great deal could be accomplished if doctors
  and other health professionals took time, at the
  end of each consultation, to make sure the
  patient had understood the key points discussed,
  and that they felt free to ask questions.

• Source Taking Health Literacy Seriously Lancet
  2005 36695

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Resources Defining Helping Improve Health
Literacy
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Thank you!

• Contact us at
• 210-3680900 www.hau.edu.gr