What can pharmacists do to improve patient health literacy
Health literacy is defined by the WHO (2015) as “the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health”.
Ironically I feel, this definition could be quite complex for some people to understand. For me health literacy is about people understanding how to improve their health or be in full control and full understanding of their illness. What health literacy doesn’t mean, is that patients are confused by the jargon or bamboozled by the experts.
Health literacy is somewhat of a problem in England. Statistics show that health information is written at a too complex level for a staggering 43% of the working age population. This figure jumps to 61% when we start adding numbers.
Health care professionals would be forgiven to think that the figure stems from those in low socioeconomic areas (where we might typically associate being less literate). However this may be the downfall as to why issues around health literacy are going unnoticed – all members of the public are encountering issues around understanding patient information, even well-educated public, and this could be making it harder for HCPs to spot a patient who doesn’t fully understand what is being communicated to them. Just because your patient is smiling and nodding along at the appropriate places does not mean that your words and advice is being understood.
Only the other day I found myself confused as to when and how I should be taking my antibiotics. “Take one three times a day” can easily be confused as “take three once a day”. And what does an “empty stomach” really mean??? How quick does food digest? Is 30 minutes ok, or does it mean to wait four hours after eating. Who knows!
As an educated woman and English as my first language, there has been times that I have struggled. So what about our 7.9 million non-UK born residents, many of who will not have English as their first or primary language.*source http://www.theguardian.com/media/reality-check/2015/aug/26/daily-telegraph-8-million-foreigners-britain
Take my Japanese mother for example, who came to the UK over 30 years ago and has a fairly decent command of the English language. I am not convinced that she would realise she needed to head to “radiology” for an Xray appointment or that “phlebotomy” would be where she dropped off a sample.
So why is getting it right so important? Why should health care professionals focus on and understand the importance of health literacy?
On the simplest of levels, improved health literacy leads to better understanding and control over your medicines, illness or wellbeing which equates to a high patient satisfaction and safety. Of course there are also more serious consequences. If people are not taking thAeir medicines as intended then this issue of medicines adherence means patients aren’t getting the most out of their medicines which could result in a worsening condition or adverse side effects.
According to the World Health Organisation around 50% of us fail to take medicines correctly, while over 50% of drugs are prescribed, dispensed or sold inappropriately.
What can pharmacists do?
In your day to day practice, you’re presented with plenty of opportunities to interact with patients, chances in which you can help support your patients with their understanding of health literacy. The average community pharmacist on the high street can handle up to 700 scripts a day or more, so there are plenty of opportunities here for example where your interaction with patients could ensure that you are sharing information at the appropriate and suited level.
Ask if the patient sees or has any issues in talking their medicines
As I mentioned earlier, we all can interpret the same information differently and this therefore can present different challenges for different people. Furthermore, our differing lifestyles might mean different complications perceived in taking medicines. For example, we assume that a table that needs to be regularly taken with food three times a day will be consumed at breakfast, lunch and dinner, probably around 8am, midday and 7pm respectively. But what about the person who just can’t stomach food first thing in the morning? Not uncommon, when 2/3 of Britons don’t eat the most important meal for the day. Source http://www.telegraph.co.uk/news/uknews/7593760/Two-thirds-of-Britons-do-not-eat-breakfast.html Or what about the patient who works shift work, who may be having their “breakfast” at 5pm?
It is a super simple solution but simply asking your patient if they anticipate any issues in taking a medicine will help. Likewise, if they are already taking the medicine, find out if they have any issues. There may be linked issues relating to the medicines with their lifestyle, diet, side effects etc or they might not even be confident in what their medication is doing and how it works.
Ask open ended questions
If you receive a “yes” when asking your patients whether they understand or are happy with their medicines for example, doesn’t mean that they are. Don’t ask close ended questions as they won’t prompt your patients into opening up. Make sure that you ask open ended questions when asking about complications, side effects and health related issues.
For example, when ensuring your patients understand how to correctly take their medicines, don’t just explain and ask “does that make sense”. This close ended question will likely prompt a yes without thinking from the patient even thought this may not be the case. Perhaps ask how confidently they feel in taking the medicines, or what issues they have encountered, or if they know how the medicine will interact with their diet or other medicines.
Don’t use complicated medical jargon
For the average member of the public, medical terms will be overly complicated and not well understood. Try to avoid this where possible. Use simple terms and everyday language that you can ensure will be understood. MURs and NSAIDs might be second nature to you but think like a patient, not like a pharmacist!
For example, “chronic” to a health care professional is a long term condition but the average member of public would use chronic to mean persistently painful.
It is very easy to assume you know who would and wouldn’t understand medical information but this is a pitfall pharmacists could fall into very easily. Don’t assume that your patients know what to do regarding their medicines and health issues and also don’t assume you know who does and doesn’t understand the jargon.
Helping with health literacy
All health care professional have a role to play in ensuring that the public and their patients have a thorough understanding of health literacy. The RCGP “health literacy” guidance states that there are three levels of health literacy – functional (basic skills of reading etc), interactive (confidence to discuss their illness and treatment)and critical (patients taking control of their wider detriments of their health).
I don’t think you have to make a radical changes or implement wacky interventions here, it is the small amendments can make all the difference for patients. It is also more than patients knowing how to take their medicines correctly, but includes the confidence they have in knowing what their condition is, that they know where to look for the correct information (which isn’t always google!), knowing their options and complications and understanding what their body is going through with an illness for example.
As the RCGP health literacy report says “The NHS like all health services is having to provide more health care to more people within limited resources, the only sustainable way for this to happen is for increased health promotion and patient self-care”. Pharmacists have an important role to play in making this happen.
By Alice Dartnell:
Alice has an interest for strong leadership, business, productivity, travel, healthy living and getting the most out of life! A frequent traveller and a passion for always learning, Alice believes that you get out of life what you put in and shouldn’t be afraid of making mistakes. Alice has been working in a healthcare setting for four years and is passionate, both professionally and personally, about health. Favourite mottos include, “smile whilst you still have the teeth” and “the only thing to fear, is fear itself”.