1. Individuals with Lower Literacy Levels: Accessing and Navigating Healthcare Herbert, H. 1, Adams, J. 1, Lowe, W. 1, Leuddeke, J. 2 1 - Faculty of Health Sciences, University of Southampton. UK, 2 Brockenhurst College UK. Background An individual’s level of literacy influences their ability to function effectively in a health care environment. This in turn can mediate the individual’s health outcomes. The way that literacy influences function and health outcomes is called health literacy which is described as seeking, understanding and using health information (Buchbinder et al, 2011; Berkman et al, 2010). Different levels of health literacy include functional, interactive and critical (Nutbeam, 2000).The complex and evolving health care system, creates additional barriers to accessing and navigating health care. Methods Adults attending a 30 week literacy class were approached to take part in the study. In-depth interviews were carried out following a 3 week period of class observation and contribution to the class as a learning assistant (HH). A pilot study was conducted to inform the content and process of semi structured interviews. Participant information and consent forms were at a level 1-2 reading ability (approximately school age 11-15 years) and read aloud twice. Chosen interview questions and prompts were informed by the literature; they included: o When visiting your Doctor or having a hospital appointment, how would you describe the information they gave you? o Have you ever explained that you have difficulty reading, writing or spelling to your Doctor or nurse? What did you say? o (show NVS) This is one of the ways to look at health literacy and numeracy. What do you think of it? - How many can you answer? Interviews were transcribed and thematically analysed using a grounded theory approach. Findings were considered under each level of health literacy; functional, interactive and critical (Nutbeam, 2000). Rigour was enhanced through respondent validation and independent assessment of themes within the text. Results Functional literacy: navigating the hospital environment for an appointment was a challenge. Interactive literacy: The greatest difficulty was in this area; all found communication with clinicians challenging. The continual use of medical jargon was identified as a significant barrier in understanding. All disliked the use of written information. Critical literacy: There was less evidence of decision making. Conclusions Individuals with lower levels of literacy experienced most difficulty in the area of interactive health literacy. This indicates that perhaps greater attention and time is needed to develop the interactive skills of health care professionals so they can support people in their health care needs. Participants were not averse to having literacy screening and subsequent documentation in their clinical records. Implications for Practice These findings support further research into the use of a ‘Flag’ system to highlight peoples’ lower health literacy when accessing the NHS. However, the flag system needs to be considered alongside the development of an appropriate screening device, the up skilling of the health care professional s and the resource implications of a substantial, previously unidentified, need in the NHS. Further information may be obtained from: Dr Jo Adams, Faculty of Health Sciences, University of Southampton, UK, Email: ja@soton.ac.uk or Harriet Herbert Faculty of Health Sciences, University of Southampton, UK, Email: harriet.herbert@solent.nhs.uk Authors have no conflicts of interest. References: Berkman, N.D.., et al., 2010. Health Literacy: What Is It? Journal of Health Communication 15, 9–19. Buchbinder, et al., 2011. Health literacy: what is it and why is it important to measure? J RHEUMATOL 38, 1791–1797. NICE clinical guideline 138 http://www.nice.org.uk/nicemedia/live/13668/58284/58284.pdf Nutbeam, D., 2000. Health Promotion International 15, 259 –267. Rudd R., Anderson J., 2006. (https://www.hsph.harvard.edu/healthliteracy/files/healthliteracyenvironment.pdf ) Objectives The purpose of this study was to explore the perceptions that individuals with lower literacy levels have of accessing and navigating health care. This study also investigated individuals’ thoughts and feelings about being screened for lower literacy levels in a clinical NHS setting “It’s extremely difficult for a person like me to admit to another person that...they don’t know how to read or write, it’s very embarrassing.” P9 ParticipantAgeGenderLiteracy level P2 (J)52FE2 P8 (I)63FL1 P9 (J)57ME2 “That was quite sort of difficult, sort of like knowing which room, you know actually place you had to be in, in the hospital, could sometimes get confusing.” P2 “They came out with some word that was three miles long, and I sat there and said what does that mean?” P9 “No, it’s no use to me. It’s got to be, shown.”P8 “They write to my doctor first, they don’t write to me anymore, they write to my doctor first, my doctor calls me in and he says “look XXXX, this is what’s going to happen...” P9 “No I've just, no I just generally go away and hope for the best.” P2 Yeh, I’d prefer them to know, because actually when I go into hospital now I call the staff nurse over and say, right, I can’t read, I can’t write and I’d like to know everything, word for word what’s going on. P9 Motivation for literacy assessment: Participants supported the idea of literacy screening in the NHS because they felt this would help them to navigate clinical systems. However, strong feelings of anxiety and embarrassment make this a sensitive and complex area.