Improving health literacy: How GPs can help

The Australian Bureau of Statistics (ABS) has released its National Health Survey: Health Literacy, 2018, the first time comprehensive national information on this issue has been published anywhere in the world.
 
The survey’s questionnaire covers respondents’ feelings about health literacy, defined by the World Health Organization as ‘the ability of individuals to gain access to, understand and use information in ways which promote and maintain good health’, dividing their answers into nine domains, including ‘having sufficient information to manage my health’ and ‘social support for my health’.
 
‘It’s a very useful questionnaire,’ Professor Mark Harris, GP and Professor of General Practice at the University of New South Wales, told newsGP. ‘These nine domains are meant to help us to focus in on some of the specific things that need to be done to improve health literacy.’
 
The survey’s results deliver some good news – and improvements since the last survey in 2006, conducted with different methodology – showing that many Australians feel very positive about their levels of health literacy. For example, one-third of Australians (33%) found it always easy to discuss health concerns and actively engage with their healthcare providers.
 
However, the survey also reveals a decline in positivity in health literacy as respondents experience greater illness, particularly among those with long-term health conditions and psychological distress.
 
For example, in domain six, ‘ability to engage with healthcare providers’, 22% of people with a disability, a restrictive long-term condition or profound core activity limitation found it difficult to engage with healthcare providers, compared to only 10% of those without a disability.
 
According to Professor Harris, these kind of results point towards a health gap that strongly needs to be filled – particularly as the number of Australians experiencing long-term illness continues to grow.
 
‘This [survey] highlights the issues around engagement in navigating the health system, and people having the information they need to help them manage their own health,’ he said.
 
‘We know that is very important – particularly in the era of long-term conditions like diabetes and heart disease. If even a quarter of the population don’t have that information, that is significant and we really need to find a way of addressing it.’
 
While Professor Harris believes the survey reflects positive developments in health literacy among healthy people, he also suspects the decline in positivity as people experience a greater burden of illness reveals a certain overestimation of health literacy in people who are well.
 
‘I think some people who are not sick and don’t have a disability have lower needs, so it’s partly that they’re less aware of what level of information, navigation and engagement they are meant to have,’ he said.
 
‘So ignorance is bliss, in a way.
 
‘Whereas, part of the reason people with multiple conditions and disability would be aware of the difficulty engaging or navigating or managing their health, is that they are having to do more of it.’
 
Professor Harris believes the data reveals more work needs to be done within the healthcare system for some of Australia’s most vulnerable patients – and that GPs can be instrumental in these efforts.
 
‘[The data] suggests some of the people that most need to be engaging and interacting with healthcare providers are more likely to find it difficult,’ he said.
 
‘It’s hard to know from the survey what the reasons are for that; it could be that people with serious illnesses have had to see multiple providers, and that can affect the ability to engage and feel able to discuss things with the providers.
 
‘So it underlines the importance of having continuity of care and having a provider that you feel you can talk to about your health problems – and that’s what general practice is all about.’
 
Clearly, it is not feasible to conduct such a questionnaire in the waiting room to identify those who may be struggling with health literacy. But Professor Harris suggests a simple but effective technique that can be used during consults to quickly identify such patients: the teach-back method.
 
‘This is when you ask people to say back to you what you just explained,’ he said.
 
‘That can be done in a number of different ways; some people say, “Tell us what you would say to your partner or spouse about what we just discussed”. Or, “I want to check that I’ve explained things properly, can you tell me what you’ve understood by what I’ve said”.
 
‘It’s very powerful, because it’s very humbling. But it also immediately identifies those patients who are in that struggling group, in a way that nothing else does.’
 
While the initial release of the ABS health literacy survey is already helpful in suggesting areas of improvement within the health system, Professor Harris is looking forward to further analysis of its data.
 
‘For example, it would be interesting to analyse the proportion [of people] that had difficulty in one or more domains,’ he said.
 
‘There might be one group of people that have got problems with lots of the domains, or it might be that you’ve got a large group of people that have difficulty in one of the domains.
 
‘I think that’s part of the value of this particular survey instrument – it’s a good tool. But we need to analyse this data in more depth to really understand what’s going on.’

ABS Australian Bureau of Statistics disability health literacy long-term disease