Abstract
Low health literacy is an issue with high prevalence in the UK and internationally. It has a social gradient with higher prevalence in lower social groups and is linked with higher rates of long-term health conditions, lower self-rated health, and greater difficulty self-managing long-term health conditions. Improved medical services and practitioner awareness of a patient’s health literacy can help to address these issues. An intervention was developed to improve General Practitioner and Practice Nurse health literacy skills and practice. A feasibility study was undertaken to examine and improve the elements of the intervention. The intervention had two parts: educating primary care doctors and nurses about identifying and enhancing health literacy (patient capacity to get hold of, understand and apply information for health) to improve their health literacy practice, and implementation of on-screen ‘pop-up’ notifications that alerted General Practitioners (GPs) and nurses when seeing a patient at risk of low health literacy. Rapid reviews of the literature were undertaken to optimise the intervention. Four General Practices were recruited, and the intervention was then applied to doctors and nurses through training followed by alerts via the practice clinical IT system. After the intervention, focus groups were held with participating practitioners and a patient and carer group to further develop the intervention. The rapid literature reviews identified (i) key elements for effectiveness of doctors and nurse training including multi-component training, role-play, learner reflection, and identification of barriers to changing practice and (ii) key elements for effectiveness of alerts on clinical computer systems including ‘stand-alone’ notification, automatically generated and prominent display of advice, linkage with practitioner education, and use of notifications within a targeted environment. The findings from the post-hoc focus groups indicated that practitioner awareness and skills had improved as a result of the training and that the clinical alerts reminded them to incorporate this into their clinical practice. Suggested improvements to the training included more information on health literacy and how the clinical alerts were generated, and more practical role playing including initiating discussions on health literacy with patients. It was suggested that the wording of the clinical alert be improved to emphasise its purpose in improving practitioner skills. The feasibility study improved the intervention, increasing its potential usefulness and acceptability in clinical practice. Future studies will explore the impact on clinical care through a pilot and a randomised controlled trial.
Highlights
Health literacy can be defined as ‘the motivation, knowledge and competencies to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life throughout the course of life’ [1]
The feedback from the practitioners indicated that more information should be given about how the alerts are generated and what they indicate, i.e., that they are not ‘diagnostic’ of low health literacy but rather act as a reminder to the practitioners to use the knowledge and skills acquired through training, and will appear when patients are at greater risk of having low health literacy in view of their socio-demographic characteristics and where they live
Health care practitioners have a key role in developing the health literacy responsiveness of health systems to ensure that they address the health literacy needs of the people they serve
Summary
Health literacy can be defined as ‘the motivation, knowledge and competencies to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life throughout the course of life’ [1]. In England, the data available on population health literacy measure only functional skills. The prevalence of low functional health literacy in the English working-age population is 43%, rising to 61% when understanding health information involves numeracy skills [5]. Low health literacy is associated with lower self-rated health and higher rates of long-term health conditions [3,4]. People with inadequate and problematic health literacy and a chronic health condition find their health condition more limiting than people with adequate health literacy and a chronic health condition, and people with lower health literacy have a greater frequency of contacts with the health service than people with higher health literacy [4]
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