1. Health literacy Impact and action at a national level 26 July, 2014 Nicola Dunbar Director, Strategy and Development

2. What is health literacy? HEALTH LITERACY Skills / Abilities Demands / Complexity Parker R, Measuring health literacy: Why? So what? Now what? In: Hernandez L (ed), Measures of Health Literacy: Workshop Summary; Roundtable On Health Literacy, 2009.

3. What is health literacy? Individual health literacy: The skills, knowledge, motivation and capacity of a person to access, understand, appraise and apply information to make effective decision and about and health care and take appropriate action Health literacy environment: The infrastructure, policies, processes, materials and relationships that make up the health system and have an impact on the way in which people access, understand, appraise and apply health-related information and services

4. Individual health literacy in Australia 59% of Australians have a level of individual health literacy that is below the “minimum required for individuals to meet the complex demands of everyday life” Influences tasks such as: reading and understanding medication instructions completing consent forms finding a healthcare provider and making an appointment understanding signage Australian Bureau of Statistics. Health Literacy, Australia, 2008.

5. Health literacy by state Australian Bureau of Statistics. Health Literacy, Australia, 2008.

6. Is this a problem? People with low levels of individual health literacy: more likely to have poorer outcomes less likely to use preventive services more likely to be hospitalised poorer medication adherence poorer knowledge and understanding of their own condition less likely to attend appointments for older people – poorer overall health status and higher risk of death Berkman et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review, 2011 Bush et al. Advancing Health Literacy Through Primary Health Care Systems, 2010

7. Is this a problem? Complex health system: who to see for what problem how to navigate among many potential care providers Complex health services: how to find your way in a hospital what to do before / during / after a visit to a GP or specialist Complex interactions: asking questions sharing decision-making Complex information: medicines information, informed consent, discharge instructions many sources of information – what can be trusted?

8. What is happening at a national level about health literacy? 1990s – National Health Goals and Targets 2010 – Australian Framework for Safety and Quality in Health Care 2012 – Australian Goals for Safety and Quality in Health Care

9. What is happening at a national level about health literacy? National health literacy stock take 2011-12: 66 submissions – over 200 separate initiatives Many different organisations doing work to improve health literacy A range of different approaches being used Efforts fragmented with little potential for learning

10. Types of strategies and approaches

12. A national approach to addressing health literacy Embedding health literacy into systems Integrating health literacy into education Ensuring effective communication People are able to access, understand and act on health- related information

13. Strategies for addressing health literacy Embedding health literacy into systems: high level systems – standards, curricula, government policy organisational policies and procedures

14. Strategies for addressing health literacy Ensuring effective communication: appropriate health-related information information when people need it, and in the form that they need it effective interpersonal communication – education and recall, shared decision-making

15. Strategies for addressing health literacy Integrating health literacy into education: education and training for consumers about health and health literacy – children and adults education and training about health literacy for healthcare providers – needs vary depending on role education and training to improve communication

16. Everyone has a role in addressing health literacy Consumers, patients and families Discuss with healthcare providers any difficulties in understanding information Ask for more information about any part of care that is unclear Healthcare providers Assume most people will have difficulty understanding and applying complex health knowledge and concepts Use a range of communication strategies to ensure information is understood Healthcare organisations Develop and implement health literacy policies and programs GovernmentsRaise awareness about health literacy Embed health literacy principles into health policy development Education and training organisations Provide education for healthcare providers about health literacy and communication Develop education programs for consumers

17. Where to next? Addressing health literacy in a comprehensive way requires long term strategies Opportunities for coordinated national action to: raise profile of health literacy reach agreement on where and action can be taken integrate health literacy into policies and programs examine how best to measure health literacy support health care organisations and providers to improve health literacy environment examine how consumer organisations can support efforts to address health literacy promote research that addresses health literacy

18. Where to next for the Commission? Endorsement of national statement on health literacy and safety and quality by Health Ministers National action to raise awareness and foster a climate of action and collaboration Tailored resources for different groups Linking health literacy and the National Safety and Quality Standards

19. Standard 7 Blood and Blood Products Standard 10 Preventing Falls and Harm from Falls Standard 1 Governance for Safety and Quality in Health Service Organisations Standard 2 Partnering with Consumers Standard 4 Medication Safety Standard 3 Healthcare Associated Infections Standard 8 Preventing and Managing Pressure Injuries Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care Standard 5 Patient Identification and Procedure Matching Standard 6 Clinical Handover National Safety and Quality Health Service Standards – from January 2013

20. The clinical workforce providing information about blood and blood product treatment options, and the associated risks and benefits Informing patients and carers about the risk of falls and falls prevention strategies Implementing processes to enable partnership with patients in decisions about their care Consulting with consumers on patient information distributed by the organisation Information on medicines is provided in a format that is understood and meaningful Patient infection prevention and control information is evaluated to determine if it meets the needs of the target audience Informing high-risk patients and their carers about the risks, prevention strategies and management of pressure injuries Providing information to patients about how they can raise concerns about potential deterioration National Safety and Quality Health Service Standards and health literacy

21. Summary Health literacy is a safety and quality issue There has been a lot of work in Australia for some time, but it is fragmented Commission is starting to coordinate a national approach: embedding health literacy into systems ensuring effective communication integrating health literacy into education Everyone has a role in addressing health literacy nicola.dunbar@safetyandquality.gov.au www.safetyandquality.gov.au