Health literacy: Perspectives from Australia - PowerPoint PPT Presentation

Loading...

PPT – Health literacy: Perspectives from Australia PowerPoint presentation | free to view - id: 65fd56-MmI5M



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Health literacy: Perspectives from Australia

Description:

Health literacy: Perspectives from Australia Don Nutbeam University of Sydney, Australia What we need to ... – PowerPoint PPT presentation

Number of Views:62
Avg rating:3.0/5.0
Slides: 32
Provided by: gled87
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Health literacy: Perspectives from Australia


1
Health literacyPerspectives from Australia
  • Don Nutbeam
  • University of Sydney, Australia

2
What we need to know it cant be said more
eloquently
  • Reports that say that something hasn't happened
    are always interesting to me, because as we know,
    there are known knowns there are things we know
    we know. We also know there are known unknowns
    that is to say we know there are some things we
    do not know. But there are also unknown unknowns
    - the ones we don't know we don't know

3
Presentation objectives to answer some
questions
  • What is health literacy ?
  • What is the state of the science?
  • Why is it a useful concept in public health?
  • Where do we go from here?

4
What is literacy?
  • What is it?
  • Functional literacy focuses on the ability to
    read basic text and write a simple statement on
    everyday life
  • Why do we care?
  • Those who are functionally literate are able to
    participate more fully in society, and are able
    to exert a higher degree of control over everyday
    events
  • How big is the problem?
  • Estimates of the proportion of the population in
    OECD countries lacking functional literacy skills
    range from 7 to 47 (UNDP, 2007)
  • http//hdrstats.undp.org/indicators/30.html

5
Literacy and health
  • Relationship between low literacy and a range of
    health related outcomes well established
  • Some indirect effects
  • Employment
  • Income
  • Some direct effects
  • Engaging in preventive health practices
  • Early detection of disease
  • Access to health care
  • Management of chronic disease
  • Dewalt DA et al Literacy and health outcomes a
    systematic review of the literature. Journal of
    General Internal Medicine, 19. 128-39 2004

6
The emergence of the concept of health literacy
  • The concept of health literacy emerged from
    different roots
  • in clinical care, mainly from the US
  • in public health, from Australia, and more
    recently Canada and the UK
  • The two different roots led to quite different
    conceptualizations of health literacy as a risk
    and as an asset

7
What is health literacy?
  • Health literacy in clinical care
  • emanating from concerns about the impact of low
    literacy on patient care
  • health literacy is seen more as a risk or deficit
    that needs to be mitigated,
  • set of capacities that act as a mediating factor
    in achieving health and clinical outcomes.

8
What is health literacy?
  • US Institute of Medicine defines health literacy
    as
  • The degree to which individuals have the
    capacity to obtain, process and understand basic
    health information and services needed to make
    appropriate health decisions
  • But recognition of social context of health
    literacy
  • based on the interaction of the individuals
    skills with health contextsand broad social and
    cultural factors at home, at work and in the
    community
  • Institute of Medicine. Health Literacy A
    Prescription to End Confusion. Washington DC,
    National Academies Press 2004

9
What is health literacy 1?
  • Health literacy is a set of individual
    capabilities in four domains
  • Cultural and conceptual knowledge
  • Speaking and listening skills
  • Writing and reading skills
  • Numeracy
  • Focus on individual capacities indicates that
  • health literacy may be developed (and can
    decline)
  • Health literacy is partly knowledge based, and
    may be developed through educational intervention
  • Health literacy is context specific and subject
    to influence by health care interactions and
    structures
  • For a thoughtful examination and critique of the
    IOM definition see Barker D, The Meaning and
    Measure of Health Literacy. Jnl of General
    Internal Medicine 21.8, 878-883. 2006

10
Health literacy and health
  • Development of measurement tools and screening
    aids (eg TOFHLA, REALM)
  • Led to more sophisticated understanding of
    health-related literacy and its association with
    a range of health practices and outcomes,
    especially
  • Effective management of chronic disease
  • Compliance with medication and other health
    advice
  • Participation in health and screening programs
  • Institute of Medicine. Health Literacy A
    Prescription to End Confusion. Washington DC,
    National Academies Press 2004

11
Figure 1 Conceptual model of health literacy as
a risk.
Tailored health information, communication,
education
Health literacy assessment - Health-related
reading fluency, numeracy, prior knowledge
12
Figure 1 Conceptual model of health literacy as
a risk.
Improved clinical outcomes
Enhanced capability for self management, improved
compliance
Tailored health information, communication,
education
Health literacy assessment - Health-related
reading fluency, numeracy, prior knowledge
13
Figure 1 Conceptual model of health literacy as
a risk.
Improved clinical outcomes
5. Enhanced capability for self
management, improved compliance
Tailored health information, communication,
education
Improved access to health care, and productive
interaction with health care professionals
Health literacy assessment - Health-related
reading fluency, numeracy, prior knowledge
Organizational practice sensitive to health
literacy
1. Barker D, The Meaning and Measure of Health
Literacy. Jnl of General Internal Medicine 21.8,
878-883. 2006 2. Paasche-Orlow MK, Wolf MS. The
causal Pathway linking health literacy to health
outcomes. American Journal of Health Behaviour
2007 31 (Supplement 1) S19-26
14
What is health literacy 2?
  • Draws upon
  • broader concepts of literacy,
  • principles of adult education,
  • concepts of health promotion

15
Drawing on wider concepts of literacy
  • Functional literacy
  • basic skills in reading and writing, capacity to
    apply these skills in everyday situations
  • Communicative/interactive literacy
  • more advanced cognitive and literacy skills,
    capacity to actively participate, derive meaning,
    apply new information quickly to changing
    circumstances
  • Critical literacy
  • most advanced cognitive and literacy skills,
    critical analysis of information, ability to use
    information to exert greater control over life
    events and situations
  • See for example Freebody P, Luke A.
    Literacies Programs Debates and Demands in
    Cultural Context. Prospect 1990 5(3) 7-16.

16
What is health literacy?
  • 2 health literacy in public health
  • origins in health education and health promotion
  • a set of capacities that enable individuals to
    exert greater control over their health and the
    range of personal social and environmental
    determinants of health.
  • health literacy is seen as an asset to be built,
    as an outcome to health education and
    communication that supports greater empowerment
    in health decision-making.

17
Principles of adult education
  • Adults have a foundation of life experiences and
    knowledge that can be used as as a resource,
    requires an understanding of learners
    experiences and communities.
  • Adults respond well to instructional materials
    that are based on students lives, sometimes
    referred to as contextualized learning,
  • Adults are autonomous and generally respond well
    to self-direction in learning, including
    involvement in program planning and
    implementation.
  • For a good overview of adult learning principles
  • S Imel Using Adult Learning Principles in Adult
    Basic and Literacy Education Clearinghouse on
    Adult, Career, and Vocational Education 1998
    http//www.cete.org/acve/docs/pab00008.pdf

18
Concepts of health promotion
  • Process of enabling people to exert greater
    control over the determinants of health
  • Includes actions directed at strengthening the
    skills and capabilities of individuals, and
  • action directed towards changing the social
    determinants of health so as to alleviate their
    impact on public and individual health

19
What is health literacy?
  • Health literacy represents the cognitive and
    social skills which determine the motivation and
    ability of individuals to gain access to,
    understand, and use information in ways which
    promote and maintain good health
  • Health literacy means more than being able to
    read pamphlets and make appointments. By
    improving peoples access to health information
    and their capacity to use it effectively, health
    literacy is critical to empowerment
  • Nutbeam D. Health Promotion Glossary. Health
    Promotion International, 13(4) 349-364. 1999
    (also - WHO/HPR/HEP/98.1)

20
Types of Health Literacy

Nutbeam D. Health Literacy as a Public Health
Goal A challenge for contemporary health
education and communication strategies into the
21st Century. Health Promotion International .
15 259-67. 2000
21
Types of Health Literacy
22
Types of Health Literacy
23
Improved Health Literacy
Developed knowledge and capability
Tailored information, communication, education
Prior understanding of individual capacity -
reading fluency, numeracy, existing knowledge
Figure 3 Health literacy as an asset a simple
linear model
24
Improved health outcomes, healthy choices and
opportunities
Changed health behaviours and practices
Improved Health Literacy
Developed knowledge and capability
Tailored information, communication, education
Prior understanding of individual capacity -
reading fluency, numeracy, existing knowledge
Figure 3 Health literacy as an asset a simple
linear model
25
10. Improved health outcomes, healthy choices
and opportunities
7. Changed health behaviours and practices
6. Improved Health Literacy
5. Skills in negotiation and self management
4. Skills in social organization and advocacy
3. Developed knowledge and capability
2. Tailored information, communication, education
1. Prior understanding of individual capacity -
reading fluency, numeracy, existing knowledge
Figure 3 Developing interactive health literacy
skills
26
Improved health outcomes, healthy choices and
opportunities
Participation in changing social norms and
service practices
Engagement in social action/advocacy for health
Changed health behaviours and practices
Improved Health Literacy
Skills in negotiation and self management
Skills in social organization and advocacy
Developed knowledge and capability
Tailored information, communication, education
Prior understanding of individual capacity -
reading fluency, numeracy, existing knowledge
Figure 3 Developing interactive and critical
health literacy skills
27
Measurement of health literacy
  • Current measures (such as TOFLA and REALM) now
    well established in the US - useful for clinical
    screening, but limited for research purposes and
    wider population assessment
  • Limited in the extent to which they focus on
    reading (and numeric) skills, and not oral
    communication
  • Focus on ability to comply with pre-determined
    behaviours
  • If health literacy depends on the relationship
    between individual communication capacities, the
    health care system, and broader society, then
    measures only at the individual level are clearly
    inadequate.
  • Barker D, The Meaning and Measure of Health
    Literacy. Jnl of General Internal Medicine 21.8,
    878-883. 2006

28
Measurement of health literacy
  • More comprehensive measures being developed - In
    the US, the Health Activity Literacy Scale (HALS)
    includes different health related competencies in
    five domains such as health promotion, disease
    prevention, and health care systems
  • Different measurement tools will be required for
    different ages and stages in life
  • Different measures will be required to
    distinguish between functional, interactive and
    critical health literacy.
  • These measures will need to include assessment of
    a persons ability to
  • gain access to age and context specific
    information from a variety of different sources
  • discriminate between sources of information
  • understand and personalise health information
    that has been obtained
  • appropriately apply relevant health information
    for personal benefit

29
Summary remarks What is the state of the
science the known knowns?
  • Good research in clinical settings linking poor
    health- related literacy with range of clinical
    outcomes
  • Some intervention trials in clinical settings
    demonstrate potential effectiveness and cost
    savings
  • Undeveloped but promising research outside health
    care settings (schools, adult education,
    E-learning)
  • Relatively little evidence of systematic
    incorporation of health promotion concepts and
    adult learning principles
  • Progress in development of measures of
    health-related literacy in clinical settings, but
    limited progress in development of comprehensive
    measures

30
Summary remarks Where to from here in research
the known unknowns
  • Development of measures that incorporate wider
    set of skills and capacities represented by
    health literacy - eg inclusion of measures of
    knowledge of social determinants of health, and
    knowledge related self-efficacy
    (confidence/capacity to act)
  • Continue to broaden research outside of health
    care setting and disease groups into schools,
    adult learning, community development eg
    maternal health literacy, school health literacy
    etc

31
Summary remarks where to from here in practice
development- the unknown unknowns
  • Health literacy fundamentally dependent upon
    levels of basic literacy in the population make
    links between these two social goals,
  • Developing self confidence to act on knowledge
    and the ability to support others requires more
    personal, and community-based educational
    outreach incorporation of adult learning
    principles and health promotion concepts
  • Promoting greater independence and empowerment
    requires acknowledgement of political aspect to
    education, focussed on overcoming structural
    barriers to health
About PowerShow.com