National Literacy Trust Hubs: Understanding the role of literacy in public health – 2015 [UK]
This paper from the UK National Literacy Trust argues that low literacy negatively impacts on the health of communities. The inability to access and interpret information stemming from a lack of basic skills presents individuals with challenge managing their own health. As a result, health literacy skills should be considered an integral part of any public health strategy, and it is essential that literacy skills underpin such strategies. The researchers argue that improving health literacy will empower communities, reduce health inequalities, and reduce pressure on public services. This paper reviews broad themes from the World Health Organisation’s paper ‘Health Literacy: the solid facts’, to draw out emerging principals for effective health literacy strategies, emphasising local area approaches in this field. This paper then examines the National Literacy Trust Hubs and discusses the National Literacy Trust's work on a shared public health agenda with health providers and other community partners.
Cognitive ability and personality as predictors of participation in a national colorectal cancer screening programme: the English Longitudinal Study of Ageing – 2015 [UK]
the English NHS Bowel Cancer Screening Programme has offered biennial faecal occult blood testing to people aged 60-69 years since 2006, and to those aged 60-74 years since 2010. Analysis of the first 2.6 million screening invitations found that 54% of eligible people took up the invitation. The reasons for this low uptake are unclear. This study investigated whether participation in screening varies according to cognitive ability and personality. There is some evidence that health literacy may determine whether individuals participate in bowel cancer screening. The relationship between health literacy and various health outcomes is at least partially explained by cognitive ability. Whether cognitive ability helps explain the link between health literacy and the decision to take part in bowel cancer screening is not known. Functional health literacy was assessed by the researchers using a four-item comprehension test based on instructions similar to those found on a packet of aspirin bought over a shop counter. Participants were asked to read an enlarged, fictitious medicine label. They were able to refer to the label while responding to the questions asked by the interviewer, such as “What is the maximum number of days you may take this medicine?” and “List one condition for which you might take the tablet.” The researchers found that of the 2681 participants, 58% had participated in screening. Non-participants were older, more likely to be male, had lower scores for cognitive function, lower scores for health literacy, lower levels of the personality traits openness to experience, extraversion, and conscientiousness, and were more likely to be in the lowest fifth of the distribution as regards household wealth.
Conceptualising patient empowerment: a mixed methods study – 2015 [UK]
Interventions and health policy programmes have been established to promote patient empowerment, with a particular focus on patients affected by long-term conditions (LTC) in primary care. However, a clear definition of patient empowerment is lacking, making it difficult to assess effectiveness of interventions designed to promote it. The aim in this mixed methods study was to develop a conceptual map of patient empowerment, including components of patient empowerment and relationships with other constructs such as health literacy, self-management and shared decision-making. A literature review and qualitative interviews with stakeholders were used to inform the development of the concept map. The review identified three levels of principles underpinning patient empowerment: the patient level, healthcare provider level, and the healthcare system level. Each level has responsibilities to support patients with LTC to self-manage their condition by optimising healthcare services. Nutbeam's model of health literacy was included as one indicator of patient empowerment because patients need to be able to understand medical information in order to contribute to shared decision-making and manage their own LTC. The researchers suggest that training interventions for healthcare providers and patients may be effective tools for developing patient empowerment. Communication, motivation and counselling skills were recommended for health care providers. Training in finding and evaluating health information on the Internet were recommended for patients.
Option Grids to facilitate shared decision making for patients with Osteoarthritis of the knee: protocol for a single site, efficacy trial – 2014 [UK]
Despite evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers including culture, attitudes, resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option grids are one-page evidence-based summaries of the available condition-specific treatment options and frequently asked questions. They are designed to be brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations. This paper describes the design of a stepped wedge exploratory trial to assess whether an option grid for osteoarthritis of the knee facilitates SDM, and explores the use of option grids by patients disadvantaged by language or limited health literacy.
Can community-based peer support promote health literacy and reduce inequalities? A realist review – 2015 [UK]
Community-based peer support (CBPS) has been proposed as a potentially promising approach to improve health literacy and reduce health inequalities. Peer support, however, is described as a public health intervention in search of a theory, and as yet there are no systematic reviews exploring why or how peer support works to improve health literacy. This review (191 pages), by Harris et al (2015) for the National Institute for Health Research, is a participatory realist synthesis and is aimed at developing a better understanding of the potential for CBPS to promote better health literacy and reduce health inequalities. Studies written in English describing CBPS research/evaluation, and related papers describing theory, were included. The researchers concluded that peer-support programmes have the potential to improve health literacy and reduce health inequalities but potential is dependent upon the surrounding equity context. More explicit empirical research is needed, which establishes clearer links between peer-supported health literacy and health inequalities.
Health literacy. Report from an RCGP-led health literacy workshop [UK]
This report, from the Royal College of General Practitioners, summarises the outcomes of a workshop on the importance of health literacy to patients and the UK National Health Service. The aim was to facilitate discussion about the principles around health literacy in primary health care contexts. The workshop ended with calls to continue discussions and develop a five-year plan of action to address the challenges of low health literacy, focusing on the themes identified in the workshop. Themes included: the challenges that health literacy brings, the importance of communication, low health literacy and health, good practice, interactive and critical health literacy.
Developing cartoons for long-term condition self-management information – 2014 [UK]
This paper, from Kennedy et al (2014), examines if the use of cartoons in patient health information materials can help patients manage their long term conditions. The authors outline the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease. Kennedy et al concluded that well-designed cartoons can help patients better manage their conditions and help health professionals address health literacy concerns.
Health literacy and numeracy: key factors in cancer risk comprehension – 2008 [US]
Health literacy, including numeracy, is essential to meaningful participation in shared healthcare decision making and has been accepted as a determinant of health. This study, by Donelle et al (2008), examined the influence of prose literacy and numeracy skills, math anxiety, education level on a patient's ability to comprehend Internet-based colorectal cancer prevention information. The findings of this study highlight the importance of presenting web-based information in a way that accommodates diverse health literacy and numeracy levels.
A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers 
This research article by Flynn et al (2013) analysed twenty-six tools used to support decision making or patient understanding in the treatment of acute ischaemic stroke with intravenous thrombolysis. Analysis found that these tools have been sub-optimally developed. Patient information tools were presented at a level that would not be understood by patients / relatives with low health literacy and numeracy skills. The great majority of tools lacked comprehensive development processes involving clinicians and patients; failed to convey information on a full range of range of outcome states; and did not adhere to good practice on presentation of outcome probabilities. Flynn et al (2013) concluded that the value of tools for supporting decision making would be enhanced by involving patients in design and testing and taking health literacy levels into consideration.
Matching clinical information with levels of patient health literacy [UK]
Good communication between healthcare professionals and patients is central to therapeutic relationships, and patients need to know how to access, understand and make use of services and information to promote and maintain their health. This article, by Jo Protheroe and Gill Rowlands (2013), describes how practising effective communication can improve patient care and how nurses, with their central role in patient advocacy, are well placed to become health literacy champions for their patients and the wider National Health Service. Healthcare professionals should take a ‘universal precautions’ approach to communication with patients, not just when health literacy is obviously low.