Health literacy for healthcare providers

Health literacy is about knowing how to:

• find your way around the many different parts of the health system
• understand your health condition(s), including what makes it better or worse
• use your medicines safely
• give informed consent to medical procedures
• prevent illness and your health getting worse
• manage long-term health conditions well.

The health literacy you need changes over time as your health changes and health services change.

Historically, the language used to describe the difference between the health knowledge people had and the knowledge they needed implied the problem was with the consumer. People were described as having ‘low health literacy’. This consumer-deficit view of health literacy is unfair as it ignores the role of the health system in creating health literacy demands and how these impact on people’s health literacy.

We now recognise that high literacy demands are created by the way health conditions are explained, managed and resourced by the health system, health services and providers.

The provision of adequate health care includes providing people with the information they need, in a way that works for them, so they can make informed decisions and manage their health.

The framework for health literacy(external link) aims to address some of the systemic issues creating barriers to health literacy. 

“Because of the way health systems are organised, individuals and whānau can often face a series of demands on their health literacy ... A health-literate health system reduces these demands on people and builds the health literacy skills of its workforce, and the individuals and whānau who use its services. It provides high quality services that are easy to access and navigate and gives clear and relevant health messages so that everyone living in New Zealand can effectively manage their own health, keep well and live well.”

Health New Zealand | Te Whatu Ora developed the framework in 2015 because it is committed to a health system that enables everyone living in Aotearoa New Zealand to live well and keep well. Building health literacy is an important part of this, and the framework outlines expectations for the health system, health organisations and all the health workforce to take action that:

• supports a culture shift so that health literacy is core business at all levels of the health system
• reduces health literacy demands
• recognises that good health literacy practice contributes to improved health outcomes and reduced health costs.

The framework also identifies some success indicators that individuals and whānau can expect to see from every point of contact with the health system.

The complexity and accessibility of health information (spoken and written), care and services affects all aspects of health: prevention, acute care, long-term conditions and public health. This complexity leads to more negative health outcomes than if spoken and written information was provided in a way that was clear and easy to access and understand.

This complexity is also an equity issue because Māori and Pacific Peoples are more likely to not have their health information needs met. This is also the case for consumer groups whose first language is not English, have a disability, use NZ Sign Language or are blind or visually impaired. In addition, care and services need to be culturally safe to meet the needs of everyone.

High health literacy demands and failing to meet health literacy needs contributes to premature morbidity and mortality, poorer access to health care, inequity, treatment/medicine safety concerns, informed consent and quality of care issues.

Healthcare providers have a responsibility to provide spoken and written information, care and services in ways that meet the needs of health consumers. Providers also need to help people understand what they need to know to live healthy lives.

In terms of spoken and written information, they need to:

• use plain language where possible (written and spoken)
• explain clinical language and words commonly used in healthcare settings including abbreviations
• identify what people know or don’t know before providing information, so new information connects to prior knowledge
• talk people through referrals to unfamiliar health services to ensure they know what to expect
• thoroughly check that people have been given the important information they need, in a way that makes sense to them, before leaving a health service
• provide information in different formats, such as videos, apps and tools and support people to use these formats
• use photos, illustrations, diagrams and other non-written aids to support written content
• review processes to identify opportunities to improve transfer of health knowledge

Health systems need to:

• build health literacy into service design
• monitor effectiveness of health literacy frameworks
• provide appropriate resources
• translate information into multiple languages
• make NZ Sign Language videos.

Video: Health literacy among Māori

Querida Whatuira-Strickland describes her work helping whānau with health literacy in her role as kaitakawaenga. (14:22)

(Health Quality & Safety Commission NZ, 2014)

Video: Health Literacy: Three steps to effective communication to support self-management

Webinar (28:37)

(Healthify He Puna Waiora, 2017)

Video: Capital & Coast DHB – non-attendance at children’s outpatient clinics

Capital & Coast DHB reviewed a service issue – non-attendance at children’s outpatient clinics. This was an issue they were already investigating and the review contributed a health literacy perspective. What CCDHB found is described in this video.

(Ministry of Health, NZ, 2015)

(Healthify & Health Literacy, NZ, 2019)

Ask, Build, Check

Use techniques such as Ask, Build, Check to improve how we communicate as health providers. The health literacy focus needs to extend beyond personal communication. Health literacy involves changing the healthcare environment and how knowledge is shared.

View these videos for examples and then start practicing this approach. 

Video: Using Ask, Build, Check: with a person with high blood pressure (3:12)

(Healthify He Puna Waiora, NZ, 2021)

Video: Using Ask, Build, Check with a person as part of their diabetes annual review (3:36)

(Healthify He Puna Waiora, NZ, 2021)

Video: Dr Rima Rudd talks about Teachback (0:59)

Dr Rima Rudd discusses health literacy and introduces the concept of 'Teachback' (also known as 'closing the loop' and 'checking understanding') at the NZ health literacy conference.

(Workbase NZ, 2012)

Video: Health Coaching (Closing the Loop): Techniques to Deliver Patient Centered Care (3:31)

Teachback is also known as Closing the Loop. In this video, we see a health coach applying this approach with a client poorly and then well. 

(N. Montgomery, 2012)

A set of training modules have been developed by Health Navigator NZ (the charitable trust which runs this Healthify He Puna Waiora website) and Health Literacy NZ covering a range of health literacy and self-management support topics. These modules will help clinicians address some of the health literacy barriers and communicate more effectively.

While designed for primary care teams, they will also be useful for secondary care providers and community organisations. 

• Each module has a training plan for the facilitator and a handout for all participants who attend the training session.
• Each participant needs a copy of the handout.
• Each session takes about one hour and follows a similar format – finding out what people already know, building on that knowledge and, at the end, an evaluation and reflection activity about the session.

Topics include: 

• Asking questions
• Listening
• Ask Build Check
• Using written and other resources
• Medicine checks

Visit the Self Management Support Toolkit website(external link) for more information and to access these modules.