Patients and Literacy, Language and Numeracy

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Patients and Literacy, Language and Numeracy

• A clinical governance issue

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We know the connection between health and
education attainment

• Women with Entry Level 2 literacy skills are more
  than twice as likely as women with Level 2 (GCSE
  level) skills to smoke every day - 42 compared
  to 19.
• Fewer than one in five men and women with Level 2
  skills report they do not exercise, this
  increases to just over one in three (35) of men
  with Entry Level 2 literacy and just under one in
  three (30) with entry Level 2 numeracy.
• Men and women with entry level skills are also
  more than twice as likely to report being in
  'very poor' or 'poor' health compared to men and
  women with Level 2 skills.
• The New Light on Literacy and Numeracy report 2006

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Adult Literacy in England 2002-03 (aged 16-65)
14.1 m
12.6 m

• 5.2 m with below level 1 literacy

3.5 m
1.1 m
0.6 m
Base all respondents w/literacy score (7873)
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Adult Numeracy in England 2002-03 (aged 16-65)

• 15 m with below Level 1 numeracy

8.8 m
8.1 m
8.1 m
5.1 m
1.7 m
Base all respondents w/numeracy score (8041)
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Speakers of other languages

• There is little systematic evidence of the scale
  of the demand for support for speakers of other
  languages
• High level of potential demand
• A distinct category with specific needs

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Patients and literacy

• 42 of patients could not understand directions
  for taking medication on an empty stomach
• 26 unable to understand information on an
  appointment slip
• 60 did not understand a standard consent form
• (findings from early published study of health
  literacy in US DW Baker et al 1998)

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What does this mean?

• Patients may not turn up for appointments
• They may have difficulty reading or interpreting
  the information on a letter or appointment card
• They may be unable to understand the 24hr clock
• They may have difficulty in calculating the time
  needed for an unfamiliar journey
• They may not be able to find their way round the
  hospital or read signage
• Adapted from the Skilled for Health 'Making the
  Case' document, available from the embedded
  learning portal

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What does this mean?

• Patients may not follow medical instructions
• They may not understand what they are told
• They may not feel confident to question
  information they don't understand
• They may not appreciate the implications of not
  following instructions
• They may not be able to understand the
  information supplied with the medicine
• Adapted from the Skilled for Health 'Making the
  Case' document, available from the embedded
  learning portal

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What does this mean?

• People may have difficulty managing their own
  health
• They may have difficulty articulating their own
  needs
• They may not know when and who to go to for
  specific health related issues
• They may not be able to access the Internet or
  interpret health related written material
• Adapted from the Skilled for Health 'Making the
  Case' document, available from the embedded
  learning portal

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Quality care?

• Health Care providers routinely take for granted
  patients ability to read and understand all
  types of health related material.
• (Parker 2000, Health Promotion International)

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What can we do?

• Ensure organisation adopts a whole organisation
  approach to LLN
• Include LLN in risk assessment
• Link to user and carer involvement and Our
  health, our care, our say.
• Consider LLN within self management and long term
  conditions
• Take account of LLN within Public Health
  priorities

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What can we do?

• Increase staff awareness
• Incident reporting and analysis to include LLN
• Plain English Policy
• Signage
• Appropriate accessible health messages
• Support programmes such as Skilled for Health
  learning resources
• Family and friends advocacy and community groups

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Skilled for Health

• The national strategy for integrating health and
  learning skills.
• A joint Department of Health, DIUS and ContinYou
  initiative.
• Now in its second phase.
• One result of phase 1 is a set of embedded health
  learning resources, downloadable from
• www.dfes.gov.uk/readwriteplus/embedded/skilled_he
  alth

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What next?