Further room for improvement in health literacy

Morgan Liotta

9/06/2021 4:33:35 PM

Recent patient feedback further establishes GPs’ stewardship role in health literacy and safeguarding quality use of medicines.

Woman looking at medication details on phone
One in five patients find health information confusing.

Findings from a recent survey that defines and measures health literacy in Australia are a clear reminder that patients need to feel better supported and more in control of their healthcare.
Published in a report commissioned from the Consumers Health Forum (CHF) by NPS MedicineWise, the survey of more than 1500 respondents identified gaps in accessing optimal healthcare where patients lack the capacity to access, understand, assess and use critical information to make health-related decisions, particularly regarding quality use of medicines.
Approximately one in five patients reported the information a health professional gave them to be ‘always or often’ confusing, and that they ‘rarely or never’ feet comfortable asking for more information or an explanation of anything they do not understand.
A further 28% said they ‘sometimes’ find such information confusing. However, just over 70% said they ‘always or often’ feel comfortable communicating about health information with their provider.
Dr Marguerite Tracy is a GP, senior lecturer at the University of Sydney’s School of Public Health, and member of Sydney Health Literacy Lab and RACGP Expert Committee – Quality Care (REC­–QC).
She told newsGP she is not surprised by the survey findings.
‘We know 60% of Australians have inadequate health literacy,’ she said.
‘To be able to participate in decisions about their healthcare, health literacy is important to patients.
‘So we need to focus on everyone when it comes to health literacy.’
And Dr Tracy says a one-size-fits-all approach is not the answer.
‘Even if someone has good general literacy, they may not have adequate health literacy,’ she said.
‘There is a clear social gradient with lower health literacy associated with lower socio-demographic factors.
‘We need to be especially careful explaining complex health concepts where patients have cultural or linguistic diversity from the doctor.
‘Aim to provide written instructions and information which are easy to read – recommended grade level less than eight, equivalent to eight years of schooling.’
Patient populations at greater risk of poor health literacy, medication literacy, and sub-optimal use of medicines include older people, Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse (CALD) backgrounds, and people with low literacy and/or low socioeconomic status.
Universal precautions – which ask practices to assume that all patients may experience difficulty understanding and using health information – should be in place, according to Dr Tracy.
‘Health literacy can be learned or improved and we can structure the information we give to people so that they have a better chance of understanding it,’ she said.
‘There are tools to help people make decisions such as decision aids, or lists of questions to help them ask questions when they see the doctor.’
Dr Tracy recommends ‘simple things we can do as GPs’, including the use of teach-back methods where doctors can say: ‘I want to be sure that I have explained clearly. Can you please explain it back to me so I can be sure I did?’. 
‘When it comes to prescribing medicines, questions such as, “Just to make sure I haven’t missed any important points, can you please explain back to me how you are going to start this medication?”, can make a significant difference to reducing medication errors,’ she said. 
‘[As can] using Universal Medication Schedule guidelines to convey and simplify dosage and use instructions, and using plain language descriptions; for example, “Take two tablets in the morning”.’
For the report, patient survey data was segmented into groups based on responses to statements on the quality use of medicines, in terms of patients’:

  • engagement with medication
  • understanding of quality use of medicines
  • attitudes towards health professionals’ role in quality use of medicines
  • attitudes towards complementary or alternative medicines.
The segmentation analysis identified three areas.

‘Preventive measures’ – 32% of respondents
Have the highest level of health literacy, rate their health as ‘good’ or ‘excellent’, want to know about the medicine before they taken it and are comfortable asking their healthcare provider. People in this group do not regularly take prescription medicines and have lower usage of healthcare services.

‘A trusted necessity’ – 30% of respondents
Have a good level of health literacy, take medication to manage ongoing health conditions, for which they have higher levels. People in this group generally have lower usage of health services and feel they are able to self-manage their medication, which they are less concerned about taking.

‘The quick fix’ – 38% of respondents
Have lower levels of health literacy, are less engaged with medicines, but have higher levels of healthcare service usage. This group had a higher proportion of CALD and Aboriginal and/or Torres Strait Islander patients.

Dr Tracy believes most GPs are open to and expect questions from their patients.

‘We know that when doctors say that they welcome questions from patients that patients are more likely to ask,’ she said.

‘I have a current paper in review where we asked GPs and other specialists their thoughts about patients’ questions and they unanimously expected questions.

‘We need to ensure that we clearly convey that message that we welcome questions, as not all patients are aware they can ask.’

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CALD health literacy patient-centred care quality use of medicines


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