Unformatted text preview: 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles Disease Prevention and Healthy Lifestyles
Consumer Health Health Literacy 1/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles What is Health Literacy?
In the report, Healthy People 2010, the U.S. Department of Health and
Human Services included improved consumer health literacy and
identi ed health literacy as an important component of health
communication, medical product safety, and oral health. Health literacy is
de ned in Health People 2010 as: “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 includes the ability to understand instructions on
prescription drug bottles, appointment slips, medical education
brochures, doctor’s directions and consent forms, and the ability to
negotiate complex health care systems. Health literacy is not simply the
ability to read. It requires a complex group of reading, listening,
analytical, and decision-making skills, and the ability to apply these skills
to health situations.
Health literacy varies by context and setting and is not necessarily
related to years of education or general reading ability. A person who
functions adequately at home or work may have marginal or inadequate
literacy in a health care environment. With the move towards a more
“consumer-centric” health care system as part of an overall e ort to
improve the quality of health care and to reduce health care costs,
individuals need to take an even more active role in health care related
decisions. To accomplish this people need strong health information
skills. Skills Needed for Health Literacy
Patients are often faced with complex information and treatment
decisions. Some of the speci c tasks patients are required to carry out
may include:
evaluating information for credibility and quality,
analyzing relative risks and bene ts, 2/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles calculating dosages,
interpreting test results, or
locating health information.
In order to accomplish these tasks, individuals may need to be:
visually literate (able to understand graphs or other visual
information),
computer literate (able to operate a computer),
information literate (able to obtain and apply relevant information),
and
numerically or computationally literate (able to calculate or reason
numerically).
Oral language skills are important as well. Patients need to articulate
their health concerns and describe their symptoms accurately. They
need to ask pertinent questions, and they need to understand spoken
medical advice or treatment directions. In an age of shared responsibility
between physician and patient for health care, patients need strong
decision-making skills. With the development of the Internet as a source
of health information, health literacy may also include the ability to
search the Internet and evaluate websites.
According to the American Medical Association, poor health literacy is “a
stronger predictor of a person’s health than age, income, employment
status, education level, and race.” In Health Literacy: A Prescription to
End Confusion, the Institute of Medicine reports that ninety million
people in the United States, nearly half the population, have di culty
understanding and using health information. As a result, patients often
take medicines on erratic schedules, miss follow-up appointments, and
do not understand instructions like “take on an empty stomach.”
Vulnerable populations include:
Elderly (age 65+)—Two thirds of U.S. adults age 60 and over have
inadequate or marginal literacy skills, and 81% of patients age 60 3/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles and older at a public hospital could not read or understand basic
materials such as prescription labels
Minority populations
Immigrant populations
Low income—Approximately half of Medicare/Medicaid recipients
read below the fth-grade level
People with chronic mental and/or physical health conditions
Reasons for limited literacy skills include:
Lack of educational opportunity—people with a high school education or lower
Learning disabilities
Cognitive declines in older adults
Use it or lose it—Reading abilities are typically three to ve grade
levels below the last year of school completed. Therefore, people
with a high school diploma, typically read at a seventh or eighth
grade reading level.
The relationship between literacy and health is complex. Literacy impacts
health knowledge, health status, and access to health services. Health
status is in uenced by several related socioeconomic factors. Literacy
impacts income level, occupation, education, housing, and access to
medical care. The poor and illiterate are more likely to work under
hazardous conditions or be exposed to environmental toxins. Economic Impact of Low Health Literacy
In addition to the e ects of low health literacy on the individual patient,
there are economic consequences of low health literacy to society. After
adjusting for health status, education level, socioeconomic status, and
other demographics factors, people with low functional literacy have less
ability to care for chronic conditions and use more health care services. 4/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles LEARNING ACTIVITY: EVALUATING LEGITIMACY OF
HEALTH-RELATED WEBSITES Use this Info Literacy Wizard to evaluate the legitimacy
of a health-related website.
Try it with this website about hot ashes and
menopause Why Does Health Literacy Matter?
Every day, people confront situations that involve life-changing decisions
about their health. These decisions are made in places such as grocery
and drug stores, workplaces, playgrounds, doctors’ o ces, clinics and
hospitals, and around the kitchen table. Obtaining, communicating,
processing, and understanding health information and services are
essential steps in making appropriate health decisions; however,
research indicates that today’s health information is presented in ways
that are not usable by most adults. “Limited health literacy” occurs when
people can’t nd and use the health information and services they need.
Nearly 9 out of 10 adults have di culty using the everyday health
information that is routinely available in our healthcare facilities, retail outlets, media and communities.
Without clear information and an understanding of the information’s
importance, people are more likely to skip necessary medical tests,
end up in the emergency room more often, and have a harder time
managing chronic diseases like diabetes or high blood pressure. What Needs to Be Done to Improve Health Literacy?
We can do much better in designing and presenting health information
and services that people can use e ectively. We can build our own
health literacy skills and help others—community members, health 5/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles professionals, and anyone else who communicates about health—build
their skills too. Every organization involved in health information and
services needs its own health literacy plan to improve its organizational
practices. The resources on this site will help you learn about health
literacy issues, develop skills, create an action plan, and apply what you
learn to create health information and services that truly make a positive
di erence in people’s lives. Who Does Limited Health Literacy A ect? Who is
a ected? Key Stakeholders
People of all ages, races, incomes, and education levels can nd it
di cult to obtain, communicate, process and understand health
information and services. Literacy skills are only a part of health literacy.
Even people with strong reading and writing skills can face health
literacy challenges when –
They are not familiar with medical terms or how their bodies work.
They have to interpret or calculate numbers or risks that could
have immediate e ects on their health and safety.
They are diagnosed with a serious illness and are scared or confused. They have health conditions that require complicated selfcare.
They are voting on a critical local issue a ecting the community’s
health and are relying on unfamiliar technical information. OPTIONAL LEARNING ACTIVITY Watch this TED video, Dr. Ben Goldacre talks about bad
science, to nd out how to be a critical consumer of news
reports of new health advice. 6/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles Ben Goldacre: Battli…
Battli… You can also watch this video on TED.com. How to Read Health News
If you’ve just read a health-related headline that has caused you to spit
out your morning co ee (“Co ee causes cancer” usually does the trick),
it’s always best to follow the Blitz slogan: “Keep Calm and Carry On.” On
reading further, you’ll often nd the headline has left out something
important, such as, “Injecting ve rats with really highly concentrated
co ee solution caused some changes in cells that might lead to tumors
eventually. (Study funded by The Association of Tea Marketing).”
The most important rule to remember is: don’t automatically believe the
headline. It is there to draw you into buying the paper and reading the
story. Would you read an article called, “Co ee pretty unlikely to cause
cancer, but you never know”? Probably not.
To avoid spraying your newspaper with co ee in the future, you need to
analyze the article to see what it says about the research it is reporting
on. Consider the following questions to help you gure out which articles
you’re going to believe and which you’re not. Does the article support its claims with scienti c research?
Your rst concern should be the research behind the news article. If an 7/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles article touts a treatment or some aspect of your lifestyle that is supposed
to prevent or cause a disease, but doesn’t give any information about the
scienti c research behind it, then treat it with a lot of caution. The same
applies to research that has yet to be published. Is the article based on a conference abstract?
Another area for caution is if the news article is based on a conference
abstract. Research presented at conferences is often at a preliminary
stage and usually hasn’t been scrutinized by experts in the eld. Also,
conference abstracts rarely provide full details about methods, making it
di cult to judge how well the research was conducted. For these
reasons, articles based on conference abstracts should be no cause for
alarm. Don’t panic or rush o to your doctor. Was the research in humans?
Quite often, the “miracle cure” in the headline turns out to have only
been tested on cells in the laboratory or on animals. These stories are
regularly accompanied by pictures of humans, which creates the illusion
that the miracle cure came from human studies. Studies in cells and
animals are crucial rst steps and should not be undervalued. However,
many drugs that show promising results in cells in laboratories don’t
work in animals, and many drugs that show promising results in animals
don’t work in humans. If you read a headline about a drug or food
“curing” rats, there is a chance it might cure humans in the future, but
unfortunately a larger chance that it won’t. So there is no need to start
eating large amounts of the “wonder food” featured in the article. How many people did the research study include?
In general, the larger a study the more you can trust its results. Small
studies may miss important di erences because they lack statistical
“power,” and are also more susceptible to nding things (including things
that are wrong) purely by chance.
You can visualize this by thinking about tossing a coin. We know that if
we toss a coin the chance of getting a head is the same as that of getting
a tail—50/50. However, if we didn’t know this and we tossed a coin four 8/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles times and got three heads and one tail, we might conclude that getting
heads was more likely than tails. But this chance nding would be wrong.
If we tossed the coin 500 times—i.e. gave the experiment more
“power”—we’d be more likely to get a heads/tails ratio close to 50/50,
giving us a better idea of the true odds. When it comes to sample sizes,
bigger is usually better. So when you see a study conducted in a handful
of people, treat it with caution. Did the study have a control group?
There are many di erent types of studies appropriate for answering
di erent types of questions. If the question being asked is about whether
a treatment or exposure has an e ect or not, then the study needs to
have a control group. A control group allows the researchers to compare
what happens to people who have the treatment/exposure with what
happens to people who don’t. If the study doesn’t have a control group,
then it’s di cult to attribute results to the treatment or exposure with any
level of certainty.
Also, it’s important that the control group is as similar to the
treated/exposed group as possible. The best way to achieve this is to
randomly assign some people to be in the treated/ exposed group and
some people to be in the control group. This is what happens in a
randomized controlled trial (RCT) and is why RCTs are considered the
“gold standard” for testing the e ects of treatments and exposures. So
when reading about a drug, food or treatment that is supposed to have
an e ect, you want to look for evidence of a control group, and ideally,
evidence that the study was an RCT. Without either, retain some healthy
skepticism. Did the study actually assess what’s in the headline?
This one is a bit tricky to explain without going into a lot of detail about
things called proxy outcomes. Instead, bear in mind this key point: the
research needs to have examined what is being talked about in the
headline and article. (Somewhat alarmingly, this isn’t always the case.)
For example, you might read a headline that claims, “Tomatoes reduce
the risk of heart attacks”. What you need to look for is evidence that the 9/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles study actually looked at heart attacks. You might instead see that the
study found that tomatoes reduce blood pressure. This means that
someone has extrapolated that tomatoes must also have some impact
on heart attacks, as high blood pressure is a risk factor for heart attacks.
Sometimes these extrapolations will prove to be true, but other times
they won’t. Therefore if a news story is focusing on a health outcome
that was not examined by the research, treat it with a pinch of salt. Who paid for and conducted the study?
This is a somewhat cynical point, but one that’s worth making. The
majority of trials today are funded by manufacturers of the product being
tested—be it a drug, vitamin cream, or foodstu . This means they have a
vested interest in the results of the trial, which can potentially a ect what
the researchers nd and report in all sorts of conscious and unconscious
ways. This is not to say that all manufacturer-sponsored trials are
unreliable. Many are very good. However, it’s worth seeing who funded
the study to sni out a potential con ict of interest. Should you “shoot the messenger”?
Overblown claims might not necessarily be due to the news reporting
itself. Although journalists can sometimes misinterpret a piece of
research, at other times the researchers (or other interested parties)
over-extrapolate, making claims their research doesn’t support. These
claims are then repeated by the journalists.
Given that erroneous claims can come from a variety of places, don’t
automatically assume they come from the journalist. Instead, use the
questions above to gure out for yourself what you’re going to believe
and what you’re not. LEARNING ACTIVITY: HEALTH IN THE HEADLINES Go to the Behind the Headlines service to read an unbiased
and evidence-based analysis of health stories that make the
news. 10/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles The service is intended for both the public and health
professionals, and endeavors to:
explain the facts behind the headlines and give a better
understanding of the science that makes the news,
provide an authoritative resource for doctors which they
can rely on when talking to patients, and
become a trusted resource for journalists and others involved in the dissemination of health news. How and Where to Find Reliable Health Information
on the Internet
The Health nder website is the federal government’s gateway for
reliable information from U.S. government agencies and other
organizations. The site displays selected resources of consumer health
and human services information. These sources have been reviewed
and found reliable and credible. Health Information on the Web
MedlinePlus Guide to Healthy Web Sur ng
Finding Reliable Health Information Online
How To Evaluate Health Information on the Internet LEARNING ACTIVITY Use this Health Website Evaluation Tool from Health on
the Net Foundation to evaluate a health website of your
choice.
Which website evaluation tool did you nd most useful
and why: 1) Info Literacy Wizard, or 2) Health Website
Evaluation Tool from Health on the Net Foundation? 11/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles The Social Life of Health Information
Where do you go for health information? According to the Pew Research
Center, most people seek information from doctors, nurses, and other
health professionals rst but the Internet and peers are also a signi cant
source.
The Pew Research Center conducted a telephone survey in 2010 to nd
out how Americans are getting their health information.
“The survey nds that, of the 74% of adults who use the internet:
80% of internet users have looked online for information about any
of 15 health topics such as a speci c disease or treatment. This
translates to 59% of all adults.
34% of internet users, or 25% of adults, have read someone else’s
commentary or experience about health or medical issues on an
online news group, website, or blog.
25% of internet users, or 19% of adults, have watched an online
video about health or medical issues.
24% of internet users, or 18% of adults, have consulted online reviews of particular drugs or medical treatments.
18% of internet users, or 13% of adults, have gone online to nd others who might have health concerns similar to theirs.
16% of internet users, or 12% of adults, have consulted online rankings or reviews of doctors or other providers.
15% of internet users, or 11% of adults, have consulted online rankings or reviews of hospitals or other medical facilities.
Of those who use social network sites (62% of adult internet users, or
46% of all adults):
23% of social network site users, or 11% of adults, have followed
their friends’ personal health experiences or updates on the site. 12/17 9/30/2019 Health Literacy | Disease Prevention and Healthy Lifestyles 17% of social network site users, or 8% of adults, have used social
networking sites to remember or memorialize other people who
su ered from a certain health condition.
15% of social network site users, or 7% of adults, have gotten any
health information on the sites.”
Where do you go for health information? According to the Pew Research
Center, most people seek information from doctors, nurses, and other
health professionals rst but the Internet and peers are also a signi cant
source. For details, see the Summary of Findings. Questions are the Answer
Your health depends on good communication. Asking questions and
providing information to your doctor and other care providers can
improve your care.
Quality health care is a team e ort. You play an important role. One of
the best ways to communicate with your doctor a...
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