1. The Innovative Panacea for Pasifikans’ Health
Health Literacy:
The Innovative Panacea
for Pasifikans’ Health
Health Literacy: a Panacea or Killer?
A relatively new concept!
Health literacy is a relatively new concept, that will provide many of the answers for community participation in health care e.g. Compliance. Currently lack of health literacy is killing Pacific peoople e.g lack of access to life saving services eg tangulu service, etc
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

2. Nursing With No Innovation: Is Routine Care Without Passion
‘Eseta Fifita-Finau, ONZM
Community Liaison Officer
Pasifika Medical Association
Sitaleki ‘A Finau, MNZM
CEO Masilamea Press &
Manager Division of Research, Information and Innovation, Tongan Community Development )
Health literacy applies to all including nurses because we have nursing training dosen’t mean you’re health literate because health literacy includes using health knowledge for action to achieve health, personally, your family, and your community.
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

3. Contents of this session:
Introduction
Define literacy and health literacy
Importance of Health literacy
Discuss the uses of health Literacy
Measurement of health literacy
Health literacy and Immunization
Useful resources for Health literacy
Conclusion

4. Life is ‘unity in diversity’
We are many NOT one!
Pasifikans are :
Multi-cultural
Multi-ethnic
Multi-religious
Multi-linguistic
Multi-ply
Life is ‘unity in diversity’

5. What is ? multi-ply, etc., not homogenous!
UNESCO defines literacy:
as the "ability to: identify, understand, interpret, create, communicate, compute,
and use printed and written materials associated with varying contexts, e.g. health
For Pasifikans, literacy, and thus health literacy is :
multi-ply, etc., not homogenous!

6. What is Literacy ?
Literacy involves a continuum of learning, enabling individuals to:
achieve their goals;
Develop their knowledge, & potential; and
Participate fully in their community & wider society.

7. What is Health Literacy ?
‘Health literacy is the degree to which individuals have the capacity to: obtain, process, & understand basic health information & services;
in order to make appropriate health decisions’
Health Literacy is one of the many functional literacies necessary to navigate complex systems and new environments/societies. H

8. There are Many Functional Literacies
Visual Literacy
Computer Literacy
Cultural Literacy
Media Literacy
Scientific Literacy Spatial Literacy
Information Literacy
Mathematical Literacy Historical Literacy

9. Importance of Health Literacy
Health literacy comes from a convergence of education, cultural & social factors, and health services.
Health literacy is fundamental to
the objectives of health promotion
There is no health promotion and thus no health without health literacy
Poor health literacy create health disparities
and the NZ Inverse Care Law
The people who needs care most get the least care (NZ inverse care law)
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

10. Examples of the Uses of Health Literacy
You are using health literacy skills when you:
follow instructions on how to take a medication;
read a brochure to determine your medical benefits;
use information on food or product labels to calculate nutritional content;
see a notice & determine whether to screen or immunize;
fill out a benefit application or patient history form
read an article about nutrition
read a letter on medical test results
Not enough to just say take 2 tablets 3 times a day. Need to go the extra mile so they could understand e.g. Why and how long to take tablets

11. Health Literacy & education
Health literacy is not only about education.
While reading, writing, & math skills make up part of the basis of health literacy, many other skills & abilities are also important:, such as:
Speaking, listening,
Having adequate background information, &
ability and courage to advocate for oneself in the health system.
Educators and researchers must add health literacy into educational & research plans
Ref: Report Brief: Health Literacy: A Prescription to End Confusion (2010)

12. Measuring Health Literacy
Health literacy: measures how well you can understand & use health information. Materials included in this measure are judged to be related to one of 5 activities associated with where & why people take health actions.
These 5 activities involve: health promotion; health protection; disease prevention; health care & maintenance; & accessing services or navigating the health system.
Transmission of information = {Health promotion}
is inadequate
Health literacy enhance informed action
HP – giving information

13. Ways to Measure Health Literacy
Functional measurements:
ALLS – Adult Literacy and Life Skills Survey
TOFHLA – Test of Functional Health Literacy in Adults
Tests reading, comprehension, and numeracy in English
Broadly corresponds with education (in English language)
Holistic assessment which includes:
Cultural understandings, Attitudes to wellness,
Expectations of health, & recognises different kinds of health literacies
There are two main ways of measuring health literacy levels:
Functional measurement looks at measuring skill levels such as the ability to read and comprehend health information. For example, in the TOFHLA, interviewees are asked to read medical instructions and insert missing words to make the instructions make sense. Further, functional measurement can look at numeracy skill levels. In the TOFHLA, for example, interviewees are asked to read prescription bottle labels and then answer a series of questions about dosage and timing etc.
Functional measures of literacy in English are positively correlated with formal educational level in English. Formal educational level is the strongest predictor of subsequent literacy level (Culligan, Arnold, Noble, & Sligo, 2004).
2) Holistic assessment incorporates individual and group understandings of health, attitudes to wellness, expectations of health, and the cultural understandings that impact on health access and engagement practices. There are structured qualitative health literacy assessments such as ‘The Health Literacy Environment of Hospitals and Health Centres’ (Rudd & Anderson, 2006) which looks at the environment of health centres from a consumer viewpoint. There are also individual qualitative health literacy assessments.

14. Pasifikans and Health Literacy in NZ
In NZ, majority of Pasifika adults have low level one or two LLN skills – of a possible 5 levels (Lawes, 2009)
1.62 million (50%) adult New Zealanders have poor ‘health literacy’ skills (Ministry of Health, 2010)
Compared to the total NZ population, Pasifikans have poorer health outcomes over a wide variety of measures
References: Lawes, E. (2009). Literacy and life skills for Pasifika adults: Results from the Adult Literacy and Life Skills (ALL) Survey.
Ministry of Health. (2010). Korero Mārama: Health literacy and Maori. Ministry of Health: Wellington, NZ.
Lawes (2009) analysed the literacy, language (in English) and numeracy capabilities of the sample of Pasifika people who took part in the 2006 Adult Literacy and Life Skills Survey. In all age groups (16-24, 25-34, 35-44, and 45-65) the majority (62% to 95%) of Pasifika adults had level one or two skills. Level one and two are the two lowest levels out of a possible five, with level three considered to be adequate.
In the same survey, it was found that overall, 1.62 million adult New Zealanders have poor ‘health literacy’ skills. Health literacy can be defined 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“ (US Department of Health and Human Services, 2000).
Given the established relationship between low levels of literacy and poor health (see Sligo, Comrie, Olsson, Culligan, & Tilley, 2005 for an example), it is likely that improvements in health literacy would assist many New Zealanders including Pacific Peoples to access and engage with health services.

15. The Need for Health Literacy in the Pacific:
According to a recent Micronesian survey, 80% want more information on health: 22% said that health information was ‘very’ or ‘sort’ of hard to understand.
Other studies found patients with high blood pressure, diabetes, asthma, & HIV/AIDS; have limited health literacy (have poor knowledge of their illness & management)
Another study found those with low health literacy skills, report: a sense of shame about their skill level.
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

16. CAUSAL PATHWAYS BETWEEN HEALTH LITERACY & HEALTH OUTCOMES
1. ACCESS AND UTLIZATION OF HEALTH CARE
PATIENT FACTORS
Navigation Skills
Self-Efficacy
Perceived Barriers
SYSTEMS FACTORS
Complexity
Acute Care Orientation
Tiered Delivery Model
Occupation
Employment
Income
Social Support
Culture
Language
2.PROVIDER-PATIENT INTERACTION
Race/Ethnicity
PATIENT FACTORS
Knowledge
Beliefs
Participation in Decision Making
PROVIDER FACTORS
Communication Skills
Teaching Ability
Time
Patient-Centered Care
Health Status
Education
Health Outcome
Vision
Hearing
Verbal Ability
Memory
Reasoning
Age
3. SELF-CARE
Contributing factors to current health status, so to get to the Health Outcome you go through these stages in order to reach Health outcome
PATIENT FACTORS
Motivation
Problem Solving
Self-Efficacy
Knowledge Skills
EXTRINSIC FACTORS
Support Technologies
Mass Media
Health Education
Resources
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

17. Why look at Health Literacy?
Health literacy is the basis of health promotion
There is no health without health literacy;
Lack of access to needed: hardware, software &
human ware;
Without health literacy: Poor Health Outcomes: high non-compliance; Low use and acceptability of Services &
patient dissatisfaction, leading to decreased compliance, and poorer health;
Disparities: inequity, inequality,
& discrimination
NZ Inverse Care Law persistence
HP is to learn the information to make health decisions, HP problem is cant’ act on it, can’t navigate the system e.g. Eat vegetables, so do home gardening
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

18. Practical Outcomes of Health Literacy:
Healthful diet lead to better academic performance in children. (Better)
School health programs improve academic outcomes for children. (Davis)
Promoting students' health lead to higher academic scores & higher rates of high school completion (Vinciullo)
Health literacy help students maintain & improve their health, prevent disease, & reduce health risk behaviors. (Kann)
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

19. Health Literacy & Health Care Services
Improves navigation of Systems;
Improve use health service, e.g., better compliance;
Improve self-care and choices of care;
Improve helping others;
Improve health prevention & protection;
Improve systems management;
Reduce health risk behaviors; and
Primary healthcare without health literacy is a dangerous joke
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

20. Health literacy and preschool health programs.
Assessments of early interventions show short term benefits for the child: enhanced achievement, improved health, increased non-cognitive skills, & social competence.
In the medium term society benefits from: greater school system efficiency; reduction in special education; reduction of grade repetition; higher learning; reduction in abuse & neglect; & lower reliance on health care.
In the long term, children benefit from: higher likelihood of graduation and college enrollment; higher wages & employment; lower teen pregnancy; less delinquency.
Society benefits from: sound education; increased tax revenues; lower welfare dependence; and reduction in delinquency & crime. (Patrinos)

21. How to Build Health Literacy?
Nurses can help improve patients’ health literacy by:
taking time to understand the health literacy demands faced by their patients;
building patients’ health literacy; knowledge and skills over time;
ensuring patients understand the information or instructions they have been given (simply asking “do you understand?” is not enough);
participating in health literacy professional development; and
encouraging their organisation to develop and implement a health literacy action plan.
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

22. “Improving Health Literacy
To get the best health outcomes, health decisions must be based on clear & correct understanding of relevant health information & services;
People with cultures different from mainstream society may have attitudes, customs, languages at odds with normal health practices;
There are many challenges to educate, prepare, & assist people in obtaining the resources they need to make good health decisions;
Clear communication, in ethnic languages, about health information & services help create & promote health literacy; and
Value traditional medicine & local wisdom.
Ref:
Health literacy/
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

23. Pasifkans’ preferences for Health Materials
Pictures of real people, children and parents
Information provided within the context of a trusted relationship
Information needed to come across in conversations and also be in written form so points could be clarified
Information needed in different languages. Wanted resources that were ‘age appropriate’ and ‘not middle class’.
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

24. Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)
Conclusion & Summary
Ethnic specific Health literacy services Essential;
Health Literacy is protective from diseases and social ills;
Health Literacy will solve the Inverse Care Law and Disparities;
There is no Health without Health Literacy;
Health Literacy essential for improved health access, utilization, & outcomes; and
Health Literacy must be part of any health service
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

25. Health Literacy: A Prescription to End Confusion (2004)
Health Literacy is the most common cause of death among Pasifikans in NZ
Free:
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

26. For Health Consumers: ‘10 Top’ Useful Websites
particularly useful websites in alphabetical:
Cancer.gov
Centers for Disease Control and Prevention (CDC)
familydoctor.org
health finder®
HIV InSite
Kidshealth®
Mayo Clinic
MedlinePlus (English) medlineplus.gov
NIH SeniorHealth
NOAH: New York Online Access to Health
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

27. Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)
Quick Guide to Health Literacy:
Health Literacy is a wicked problem
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

28. Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)
Mālō! Haere Ra!
Questions ?
& Answers?
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)

29. Health Literacy is a Nursing ‘wicked problem’!
’Alu a koē mo
ke fiemalie
Finau, E & S.A. SPNF Conf. Melbourne (Nov. 2012)