18 October 2016
Health literacy: a dual approach to bridging the digital divide
Originally posted in Health Business, our texthelper Jason Gordon discusses low literacy in the health sector and how Assistive Technology can make access to medical services and information easier for individuals.
Low literacy is mirrored by poor health, whether it’s caused by disability or socioeconomic disadvantages. Assistive Technology can make access to medical services and information easier for individuals with literacy challenges who are the biggest consumers of healthcare resources. What’s more, AT can support the significant proportion of NHS employees whose first language isn’t English, enabling more effective, cost-efficient healthcare provision.
What is health literacy?
A clear linkage between literacy levels and public health was identified as long ago as 1992. [ref: “Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills.”]
This original conjecture has since been cited regularly by other observers. In 2013, the WHO repeated the original assertion that “literacy is a stronger predictor of individual’s health status than income, employment status, education level and racial or ethnic group.”
Closer to home, it’s a view expressed by Joe Morrisroe of the National Literacy Trust, who argues that low literacy negatively impacts on the health of communities in the UK: “The inability to access and interpret information stemming from a lack of basic skills presents individuals with a fundamental challenge to take control of 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.”
Removing obstacles to better healthcare
Poor literacy can be the result of factors such as educational attainment, often linked with limited financial and social resources. It can also be due to disabilities like dyslexia – a condition that according to the British Dyslexia Association affects 10% of the UK population, 4% to a ‘severe’ degree. Equally, individuals for whom English isn’t their first language (including ethnic minorities and recent migrants) can struggle to understand basic healthcare advice.
While the causal factors vary, the outcomes remain essentially the same. Individuals with poor literacy are less able to access information about beneficial lifestyles and self-regulate existing medical conditions such as asthma and diabetes. They may be unable to read basic nutritional information on food packaging and make less healthy choices as a result. Similarly, they may struggle to read important pharmaceutical information and medical instructions.
As Public Health England points out (September 2015), “People with limited health literacy are less likely to use preventive services and more likely to use emergency services, are less likely to successfully manage long-term health conditions and as a result incur higher healthcare costs”. WHO echoes this, pointing out that individuals with weak health literacy typically make sub-optimal lifestyle choices with a consequent drain on healthcare systems.
With 42% of working-age adults in this country unable to make adequate use of everyday health information (source: Public Health England), literacy is clearly a major barrier to helping individuals understand and manage their own health. But as the NHS shifts towards greater electronic interaction with end-users – from booking GP appointments and requesting repeat prescriptions to providing test results – there’s the danger of a growing divide between the general population and patients who may lack basic digital skills.
Of course literacy has another profound impact on the provision of healthcare. Of around 1.6 million NHS staff and community health workers across the UK, 11% are officially recognised as ‘not British’[CS1] according to data from the Health and Social Care Information Centre (HSCIC).
Counting the costs of poor health literacy – from ‘Literacy Changes Lives 2014’ by Joe Morrisroe, National Literacy Trust
- Those with inadequate literacy are up to 18 times less likely to be able to identify their medications compared to those with adequate literacy. They are also less likely to demonstrate how to take their prescription correctly.
- 9 in 10 adults (92%) with adequate literacy skills can recognise a high level blood pressure reading compared to just over half (55%) with the lowest reading level.
Our health service relies heavily on staff from overseas, with 2014 figures indicating that 73% of UK hospital trusts recruited employees from abroad who make a major contribution in all roles, from doctors and nurses to carers, porters and ancillary staff. And while doctors joining the NHS from overseas are now subjected to stringent language skills tests, not having English as a first language can be a real challenge for many employees coming to the UK from over 200 different countries.
Today, Assistive Technology has a vital dual role to play in helping healthcare providers deliver a more efficient, cost-effective service. Screen readers can help those with low literacy – and disabilities like dyslexia – understand and interact successfully with everything from personal health records to online appointment booking. Similarly, online translation tools can help almost 10% of the population for whom English isn’t their first language – including patients as well as NHS staff recruited from overseas.
Jason Gordon is a Business Development Manager at Texthelp, a company producing digital inclusion and assistive software products that are used by adults and students worldwide.