I don't really like the term ‘health literacy’. Not many people really understand what it means, which is a bit ironic when you think about it. My unofficial definition of health literacy is ‘the capacity someone has to acquire sufficient knowledge and skills to confidently participate in their own health’.
It's unreasonable to assume that any of us would feel particularly able and willing to confidently participate when faced with a health issue, unless we were medically qualified. I have several medical qualifications that confer on me a high level of health literacy, but I am no more engaged to grapple with anything else than the next person.
I completely glaze over when listening to my financial advisor, car mechanic or the chap that comes to repair the boiler. I usually nod politely at the mention of wrap provider accounts, drive couplings and oil control valves. To avoid shame I then claim absolute understanding, agree with whatever is recommended and surrender myself in complete trust and dependence that they will sort everything for the best. Then I can't remember a thing they've said.
This is exactly the same experience most of my patients have in their encounters with me, except there's bit of fear thrown in to make it worse. Also, the huge educational and cultural chasm between me and most of my patients is likely to make the encounter even more daunting for them. This would probably be okay if I was simply fixing something, but most of my patients have unfixable long-term conditions. Their outcomes are much more determined by their own knowledge, skills and confidence to look after themselves, than by my input.
So how do we change this state of affairs that does no-one any favours? Traditional approaches of patient education, information leaflets, health promotion campaigns and written care plans don't really hit the spot and have proved disappointing. Despite this they remain our chief tools in trying to ‘educate’ our patients. My own view is that most of us are probably looking at this the wrong way round.
Perhaps healthcare should take a lesson from the computer industry. Over 30 years ago IBM brought out the first home computer. Unless you were a scientist or a geek you were no more going to want one in your home than I want to repair my own boiler.
The industry could have approached this by trying to improve our computer literacy; sent us off for structured education and deluged us with information sheets on how to program in Basic. Instead they worked on making computers simpler and more engaging. None of us are any more ‘computer literate’ than we were, but we have the confidence to use computers as they now match our skills and knowledge. Whether you are 8 or 80 you can (if you want to) do complex tasks on an iPad. This approach has drastically reduced digital inequalities so maybe, just maybe, if we apply it to healthcare we can reduce health inequalities?
Let's learn from this and stop trying to solve low health literacy by locating the problem with the patient. It’s for us to make healthcare simpler and more engaging so that it matches people's abilities. Let's stop using technical words designed by lab-based biochemists such as 'Haemaglobin A1c'. It puts people off, especially when we attach numbers like '66mmols'. It's no more meaningful than my car mechanic telling me my car's carbon monoxide emissions. At least when my car gets its MOT they give me the results, colour coded using traffic lights, so I can tell if things are okay.
Unless we see health literacy as our problem rather than the patient's, we will consistently deny people the opportunity to access and participate in their own healthcare. We have little problem with this concept when our patients have a physical disability. Just as we wouldn't expect them to climb their way up stairs in a wheelchair, neither should we expect people to struggle with inappropriate intellectual obstacles.
It's not easy – peoples' knowledge and skill levels are not as obvious as a physical disability and this unintentionally perpetuates the problem. In fact people often go to extraordinary lengths to hide their lack of understanding and as a result we consistently overestimate their abilities and knowledge.
But if we are going to crack this problem we need to spend less time trying to get our patients to understand us and more time trying to understand them. The issue is not the poor health literacy of patients but the low ‘lay literacy’ of us professionals.
Graham is a GP and National Clinical Lead Self Management and Health Literacy, Scottish Government, www.twitter.com/KramerGraham
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