Health literacy – the door to improved health outcomes

Trevor Gore discusses the role of pharmacists in enhancing health literacy and tackling disparities

I have just returned from the FIP congress and one of the many conversations was focussed on developmental goal 10, which looks at Equity and equality. So, imagine my surprise to see that Pharmacy Business was running a poll titled “What should pharmacists focus on to improve global health outcomes?” Now the results aren’t in at the time of writing, but the options given were;

1) Promoting preventative care; 2) Research and development; 3) Collaborative approach and 4) Health disparities.

Having written about Collaboration in April, I thought I would turn my thoughts to Health disparities. The COVID-19 pandemic has exacerbated and deepened existing health inequalities and has also revealed that a large part of them is rooted in education and literacy levels.

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is the first of the seven pillars of self-care which is an important element in health inclusivity. Providing health information, knowledge, and skills to use that information is crucial to improving health literacy. This is particularly important in the case of minor ailments and the use of over-the-counter medicines, where pharmacists are key players in improving health literacy.

There are three categories of health literacy.

• Functional Health Literacy - concerning basic reading and writing skills needed to understand everyday health information, such as reading prescriptions, medicines labels. Instructions.
• Interactive health literacy - which refers to more advanced cognitive literacy skills that with social skills, can be used to actively participate in everyday situations, extract information and derive meaning from different forms of communication, and apply this to changing circumstances.
• Critical health literacy – the ability to critically analyse information and use this to exert greater control over life events and situations.

As many as 43% of the adult population in England have low health literacy, according to data from 2015. Low health literacy is a recognised barrier to health, contributing to poor health and higher premature mortality. Indeed, the effects of low health literacy include unhealthy behaviours, physical inactivity, smoking, unhealthy diet, non-attendance for screening and poor adherence of medication, whose rates can be as high as 50%. Remember medicines don’t work in people who don’t take them, but encouragingly the research also found that the biggest predictor of medication adherence was patient’s personal connection (or lack thereof) with a pharmacist or pharmacy staff.

In addition, people with low levels of health literacy are more likely than the general population to experience poor health and long-term chronic illnesses that they find difficult to manage. Health literacy also affects people’s use of healthcare organisations and showed people with low health literacy tend to use emergency services more and have increased hospital admissions.

When a patient comes into the pharmacy with a prescription you are not sure what information the GP has given them, and what they understood. Do you start discussing the disease, the medicines, lifestyle advice, or the patients’ individual circumstances? I saw a great cartoon recently that had a GP talking to a patient and said, “Don’t confuse your Google search with my 6 years of medical school” to which the patient replies “Don’t confuse your 1-hour lecture you had on my condition with my 20 years of living with it”.

We are all encouraged to provide person-centred care, with shared decision-making being a key part, and for it to work the patient needs to understand not only the discussed topic but also the decision implications. A healthcare discussion between a pharmacist and patient should create a friendly, respectful, non-judgemental environment that encourages two-way communication, and avoids medical jargon and abbreviations. The public rarely calls their prescription a script! The pharmacist should use easy-to-under-stand words and ask open questions (those that cannot be answered with a simple ‘yes’ or ‘no’) so “do you understand how to take your medicines” is not particularly helpful. Engagement can be sustained by using different media formats, including pictures, videos, or interactive media. Fitting the medium to the individual is also important. Tik-Tok may work for some people but not others.

Low health literacy has a profound impact on health outcomes but is not a fixed competency – people have the potential to enhance and improve their health literacy.

Pharmacists need to have an understanding of health literacy, along with the different techniques and strategies they can use to improve it, resulting in better care delivery, health access and outcomes, thereby reducing health disparities.

Remember, the best ‘medicine’ is the individual, who is informed, empowered and inspired.

Trevor Gore is the founder and director of Maestro Consulting, Trustee of the Self-care Forum  and honorary member of the Royal Pharmaceutical Society (July 2011) for services to Pharmacy education.