Health literacy for healthcare providers

People's health literacy needs change over time as their health changes and health services change.

Health literacy describes the skills and knowledge people need at any given time to:

• find their way around the parts of the health system they need to access
• understand their health conditions, including what makes them better or worse
• use their medicines safely
• give informed consent to medical procedures
• prevent illness so their health doesn’t get worse
• manage long-term health conditions well.

Historically, the language used to describe health literacy implied that low health literacy is an individual skill deficit, or community-wide deficit. People were described as having ‘low health literacy’. This person-deficit view of health literacy is unfair as it ignores the crucial role of the health system in creating or reducing complexity (eg, health literacy demands), and how delivering effective health care includes building the health literacy people and communities need.

For example, being diagnosed with a new health condition is the time when a person needs the opportunity to build new health knowledge and skills, and understand the relevant services they may now need, assisted by those with health expertise and experience. It's not fair to expect people to arrive for health care already knowing about all the possible health challenges they may encounter.

Health literacy demands describe the knowledge and skills people need to get well, manage their health and stay well. This includes the demands created by accessing and navigating health services. Understanding the health literacy demands people face when managing their health is a useful starting point for checking what might be new or unfamiliar for them.

Examples of the health literacy demands created by a health condition include:

• understanding language and jargon
• understanding symptoms
• understanding medicines and side effects
• understanding disease progression
• understanding treatment and options
• understanding nutrition and activity requirements
• skills to manage symptoms, take medicines, talk about a condition, use equipment, manage nutrition and activity.

Examples of the health literacy demands created by health services include the following:

• Arranging appointments: Understanding a letter and its instructions, making a phone call to confirm, using an online booking system, arranging time off work and transport to attend.
• Visiting multiple providers: Finding and funding appointments with primary care doctors, nurses, HIPs and health coaches, outpatient services, in-patient services, blood tests, X-rays and scans, physiotherapy, pharmacy and district nurses.
• Attending appointments: Navigating an unfamiliar environment to find a service, interacting with reception staff, answering questions, providing a history and personal details, understanding health professionals’ instructions and following referral processes.
• Accessing medicines: Understanding funding rules and safety guidance, arranging repeat prescriptions and delivery services.

The health literacy focus needs to extend beyond personal communication and involve changing the healthcare environment and how knowledge is shared.

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

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

The complexity and inaccessibility of health care, services and information affects all aspects of health – prevention, acute care, long-term conditions and public health. This complexity leads to more negative health outcomes than it would if care and services were easy to access and navigate, and information was clear and easy to understand.

High health literacy demands (health complexity) and failing to meet people's health literacy needs contributes to:

• premature morbidity and mortality
• poorer access to health care
• inequity
• treatment and medicine safety concerns
• informed consent and quality of care issues.

Healthcare providers can provide care, services and spoken and written information in ways that meet the needs or people accessing healthcare services.

In Aotearoa New Zealand there is a tool for those working in health to use with every person in every healthcare discussion, called Three steps to meeting health literacy needs(external link).

The three steps:

• reinforce the useful knowledge and skills people already have
• identify and build the knowledge and skills they need, and 
• check that healthcare providers and their staff have been effective in building knowledge and skills.

The three steps in the tool are Ask, Build and Check and are summarised as follows:

• Ask questions to identify what people think, know, do and have experienced.
• Build people’s skills and knowledge by:
  • connecting to the person’s existing knowledge
  • using plain language where possible
  • explaining clinical language and words commonly used in healthcare settings – including abbreviations (see our medical words explained page)
  • talking people through referrals to unfamiliar health services to ensure they know what to expect
  • using photos, illustrations, diagrams and other non-written aids to support spoken and written content
  • providing information in different formats, such as videos, apps and tools, and supporting people to use these formats.
• Carefully check (before people leave their appointment) that they have been given the important information they need, in a way that makes sense to them. Checking you've been clear is crucial to ensure that healthcare staff take responsibility for what they've communicated rather than thinking patients and whānau couldn't understand if they're unable to describe what's been discussed. 

Addressing health literacy extends beyond patient communication and involves changing the healthcare environment and how knowledge is shared. 

Health systems need to:

• identify the health literacy demands created by health services and reduce them where possible
• build health literacy into service design
• review existing processes to identify opportunities to build health knowledge and skills
• provide appropriate information in multiple languages and NZ Sign Language as required.

The Let's talk gout video from He Ako Hiranga shows a simulated discussion between a prescriber and a patient demonstrating the use of the three step Ask, Build, Check health literacy model. The purpose is to show how the model can be incorporated into discussions about the long term management of gout to help improve outcomes.  

Video: Let's talk gout (17:12)

Podcast

In Episode Three – Let's talk gout (part 1)(external link) you can listen to three experts discussing attitudes towards gout and how to communicate better with patients to find out what they already know about their gout to help improve their outcomes. 

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: Using Ask, Build, Check with a person with high cholesterol

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

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.