The importance of health literacy in the development of "Self Care" cards for community pharmacies in Ireland

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Abstract

Objectives: "Self Care" cards play a significant role in delivering health education via community pharmacies in Australia and New Zealand. The primary objective of this study was to evaluate whether such an initiative could have a similar impact in an Irish context. The secondary objective was to understand the importance of health literacy to this initiative. Methods: Ten cards were developed for the Irish healthcare setting and trialed as a proof of concept study. The pilot study ran in ten community pharmacies in the greater Cork area for a six-month period. Using a mixed methods approach (Questionnaires & focus group) staff and patient reactions to the initiative were obtained. Concurrent to the pilot study, readability scores of cards (Flesch-Kincaid, Fry, SMOG methods) and the Rapid Estimate of Adult Literacy in Medicine (REALM) health literacy screening tool was administered to a sample of patients. Results: 88.7% of patient respondents (n=53) liked the concept of the "Self Care" cards and 83% of respondents agreed that the use of the card was beneficial to their understanding of their ailment. Focus groups with Pharmacy staff highlighted the importance of appropriate training for the future development of this initiative. An emerging theme from designing the cards was health literacy. The pilot "Self Care" cards were pitched at too high a literacy level for the general Irish public to understand as determined by readability score methods. It was found that 19.1% of a sample population (n=199) was deemed to have low health literacy skills. Conclusion: The "Self Care" initiative has the potential to be Pharmacy´s contribution to health education in Ireland. The initiative needs to be cognizant of the health literacy framework that equates the skills of individuals to the demands placed upon them.

Translated abstract

Objetivos: Las tarjetas "Auto Cuidado" [Self Care] juegan un papel significativo en la provisión de educación sanitaria a través de las farmacias comunitarias en Australia y Nueva Zelanda. El objetivo primario de este estudio fue evaluar si una iniciativa similar podría tener impacto en el contexto irlandés. El objetivo secundario fue entender la importancia de la literacía en salud para esta iniciativa. Métodos: Se desarrollaron 10 tarjetas para el entorno sanitario irlandés y se ensayaron con un estudio de prueba de concepto. El estudio piloto corrió en 10 farmacias comunitarias en el gran Cork durante seis meses. Se obtuvieron las reacciones del personal y pacientes hacia la iniciativa con el uso de métodos mixtos (cuestionarios y grupos focales). Simultáneamente al estudio piloto, se calcularon las puntuaciones de legibilidad de las tarjetas (métodos de Flesch-Kincaid, Fry, SMOG) y se administró a una muestra de pacientes el instrumento de rastreo de literacía en salud Rapid Estimate of Adult Literacy in Medicine (REALM). Resultados: Al 88,7% de los pacientes (n=53) les gustó el concepto de tarjetas "Auto Cuidado" y el 83% de los respondentes aceptó que el uso de la tarjeta era beneficioso para la comprensión de su enfermedad. Los grupos focales con personal de la farmacia resaltaron la importancia del entrenamiento adecuado para el futuro desarrollo de esta iniciativa. Un tema emergente del desarrollo de las tarjetas fue la literacía en salud. Las tarjetas piloto "Auto Cuidado" tenían inclinación hacia un nivel demasiado elevado de literacía para que el público general irlandés las entendiese, como se determinó por los métodos de legibilidad. Se vio que el 19,1% de la muestra (n=199) estaba considerada como de bajas habilidades en literacía de la salud. Concusión: La iniciativa "Auto Cuidado" [Self Care] tiene la posibilidad de ser una contribución de la farmacia a la educación sanitaria en Irlanda. La iniciativa necesita ser consciente del marco de literacía en salud que conecta las habilidades de los individuos a las demandas que se les solicitan.

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Health literacy and public health: A systematic review and integration of definitions and models

Karen Kristine Sørensen, Stephan Van den Broucke, James Fullam … (2012)

Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

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Low health literacy and health outcomes: an updated systematic review.

Nancy D Berkman, Stacey L Sheridan, Katrina Donahue … (2011)

Approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes. To update a 2004 systematic review and determine whether low health literacy is related to poorer use of health care, outcomes, costs, and disparities in health outcomes among persons of all ages. English-language articles identified through MEDLINE, CINAHL, PsycINFO, ERIC, and Cochrane Library databases and hand-searching (search dates for articles on health literacy, 2003 to 22 February 2011; for articles on numeracy, 1966 to 22 February 2011). Two reviewers independently selected studies that compared outcomes by differences in directly measured health literacy or numeracy levels. One reviewer abstracted article information into evidence tables; a second reviewer checked information for accuracy. Two reviewers independently rated study quality by using predefined criteria, and the investigative team jointly graded the overall strength of evidence. 96 relevant good- or fair-quality studies in 111 articles were identified: 98 articles on health literacy, 22 on numeracy, and 9 on both. Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer ability to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Poor health literacy partially explains racial disparities in some outcomes. Reviewers could not reach firm conclusions about the relationship between numeracy and health outcomes because of few studies or inconsistent results among studies. Searches were limited to articles published in English. No Medical Subject Heading terms exist for identifying relevant studies. No evidence concerning oral health literacy (speaking and listening skills) and outcomes was found. Low health literacy is associated with poorer health outcomes and poorer use of health care services. Agency for Healthcare Research and Quality.