Health literacy: health professionals’ understandings and their perceptions of barriers that Indigenous patients encounter

BMC Health Services Research

Janet Smylie²  Susan Reid³  Margaret Kelaher¹  Sue Crengle⁴  Bernice Downey⁵  Joanne Luke⁶  Michelle Lambert⁴ 

[1] Centre for Health Policy, Programs & Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia;Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;Workbase Education Trust, Ponsonby, Auckland, New Zealand;National Institute of Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand;Doctoral Candidate, McMaster University, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Saint Michael’s Hospital, Toronto, Canada;The Victorian Aboriginal Health Service, Fitzroy, Melbourne, Australia

关键词: Community based participatory research;    Medication knowledge;    Cardiovascular diseases;    Health literacy;    Indigenous health;   

Others  :  1090475
DOI  :  10.1186/s12913-014-0614-1

 received in 2014-06-05, accepted in 2014-11-18,  发布年份 2014

【 摘 要 】

Background

Despite the growing interest in health literacy, little research has been done around health professionals’ knowledge of health literacy or understandings of the barriers to health literacy that patients face when navigating the health care system. Indigenous peoples in New Zealand (NZ), Canada and Australia experience numerous inequalities in health status and outcomes and international evidence reveals that Indigenous, minority, and socio-economically disadvantaged populations have greater literacy needs. To address concerns in Indigenous health literacy, a two-pronged approach inclusive of both education of health professionals, and structural reform reducing demands the system places on Indigenous patients, are important steps towards reducing these inequalities.

Methods

Four Indigenous health care services were involved in the study. Interviews and one focus group were employed to explore the experiences of health professionals working with patients who had experienced cardiovascular disease (CVD) and were taking medications to prevent future events. A thematic analysis was completed and these insights were used in the development of an intervention that was tested as phase two of the study.

Results

Analysis of the data identified ten common themes. This paper concentrates on health professionals’ understanding of health literacy and perceptions of barriers that their patients face when accessing healthcare. Health professionals’ concepts of health literacy varied and were associated with their perceptions of the barriers that their patients face when attempting to build health literacy skills. These concepts ranged from definitions of health literacy that were focussed on patient deficit to broader definitions that focussed on both patients and the health system. All participants identified a combination of cultural, social and systemic barriers as impediments to their Indigenous patients improving their health literacy knowledge and practices.

Conclusions

This study suggests that health professionals have a limited understanding of health literacy and of the consequences of low health literacy for their Indigenous patients. This lack of understanding combined with the perceived barriers to improving health literacy limit health professionals’ ability to improve their Indigenous patients’ health literacy skills and may limit patients’ capacity to improve understanding of their illness and instructions on how to manage their health condition/s.

【 授权许可】

   
2014 Lambert et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Berkman ND, Davis TC, McCormack L: Health literacy: what is it? J Health Commun Int Perspect 2010, 15(1 supp 2):9-19.
• [2]Black A: Health literacy and cardiovascular disease: fostering client skills. Am J Health Educ 2008, 39(1):55-57.
• [3]DeWalt DA, Boone RS, Pignone MP: Literacy and its relationship with self-efficacy, trust, and participation in medical decision making. Am J Health Behav 2007, 31:S27.
• [4]Gillis DE, Gray NJ, Murphy E: Multiple domains of health literacy as reflected in breastfeeding promotion practice: a Canadian case study. J Health Psychol 2013, 18:1023-1035.
• [5]Hironaka LK, Paasche-Orlow MK: The implications of health literacy on patient-provider communication. Arch Dis Child 2008, 93(5):428-432.
• [6]Kripalani S, Weiss BD: Teaching about health literacy and clear communication. J Gen Intern Med 2006, 21(8):888-890.
• [7]Nielsen-Bohlman L, Panzer AM, Kindig DA: Health Literacy: a Prescription to End Confusion. National Academies Press, Washington D.C; 2004.
• [8]Osborne H: Health literacy: how visuals can help tell the healthcare story. J Vis Commun Med 2006, 29(1):28-32.
• [9]Schillinger D, Bindman A, Wang F, Stewart A, Piette J: Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns 2004, 52(3):315-323.
• [10]Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB: Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med 2003, 163(1):83-90.
• [11]Seurer AC, Vogt HB: Low health literacy: a barrier to effective patient care. S D Med 2013, 66(2):51. 53–57
• [12]Cafiero M: Nurse practitioners’ knowledge, experience, and intention to use health literacy strategies in clinical practice. J Health Commun 2013, 18(sup1):70-81.
• [13]Jukkala A, Deupree JP, Graham S: Knowledge of limited health literacy at an academic health center. J Contin Educ Nurs 2009, 40(7):298-302.
• [14]Mackert M, Ball J, Lopez N: Health literacy awareness training for healthcare workers: improving knowledge and intentions to use clear communication techniques. Patient Educ Couns 2011, 85(3):e225-e228.
• [15]Devraj R, Herndon CM, Griffin J: Pain awareness and medication knowledge: a health literacy evaluation. J Pain Palliat Care Pharmacother 2013, 27(1):19-27.
• [16]Easton P, Entwistle VA, Williams B: Health in the “hidden population” of people with low literacy. a systematic review of the literature. BMC Public Health 2010, 10:459-468.
• [17]Paasche-Orlow MK, Wilson EAH, McCormack L: The evolving field of health literacy research. J Health Commun Int Perspect 2010, 15(1 supp 2):5-8.
• [18]Schlichting JA, Quinn MT, Heuer LJ, Schaefer CT, Drum ML, Chin MH: Provider perceptions of limited health literacy in community health centers. Patient Educ Couns 2007, 69(1–3):114-120.
• [19]Kōrero Mārama: Health Literacy and Māori Results from the 2006 Adult Literacy and Life Skills Survey. Ministry of Health, Wellington; 2010.
• [20]Australian Social Trends: Using Statistics to paint a picture of Australian Society. Cat no. 4102.0. ABS, Canberra; 2009.
• [21]Rootman I, Gordon-El-Bihbety D: A Vision for a Health Literate Canada: Report of the Expert Panel on Health Literacy. Canadian Public Health Association, Ottawa, Ontario; 2008.
• [22]Baker DW: The meaning and the measure of health literacy. J Gen Intern Med 2006, 21(8):878-883.
• [23]Mayer GG, Villaire M: Low health literacy and its effects on patient care. J Nurs Adm 2004, 34(10):440-442.
• [24]Chao S, Anderson K, Hernandez L: Toward health equity and patient-centeredness: Integrating health literacy, disparities reduction, and quality improvement. Institute of Medicine, Washington, D.C; 2009.
• [25]Marks R: Ethics and patient education: health literacy and cultural dilemmas. Health Promot Pract 2009, 10(3):328-332.
• [26]Satherley P, Lawes E: The Adult Literacy and Life Skills (ALL) Survey: age and literacy. Ministry of Education, Wellington; 2008.
• [27]Health literacy, Australia. vol. Cat no. 4233.0. ABS, Canberra; 2006.
• [28]Aspects of literacy: Assessed skill levels Australia. ABS, Canberra; 1997.
• [29]Simonds SK: Health education as social policy. Health Educ Monogr 1974, 2:1-25.
• [30]Weiss BD: Health Literacy and Patient Safety: Help Patients Understand. American Medical Association, Chicago; 2007.
• [31]Brach C, Keller D, Hernandez LM, Baur C, Parker R, Dreyer B, Schyve P, Lemerise AJ, Schillinger D: Ten Attributes of Health Literate Health Care Organizations. Institute of Medicine, Washington D.C; 2012.
• [32]Koh HK, Brach C, Harris LM, Parchman ML: A proposed ‘health literate care model’ would constitute a systems approach to improving patients’ engagement in care. Health Aff 2013, 32(2):357-367.
• [33]Devraj R, Gupchup G: Knowledge of and barriers to health literacy in Illinois. J Am Pharm Assoc 2012, 52(6):183-193.
• [34]Gaglio BA: Assessing health literacy and health information needs of persons at risk for cardiovascular disease. University of Colorado at Denver, Denver; 2010.
• [35]Paasche-Orlow MK, Wolf MS: Promoting health literacy research to reduce health disparities. J Health Commun Int Perspect 2010, 15(1 supp 2):34-41.
• [36]Nutbeam D: Health literacy as a public goal: a challenge for contemporary health education and communication strategies in the 21st century. Health Promot Int 2000, 15(3):259-267.
• [37]Pignone M, DeWalt DA, Sheridan S, Berkman N, Lohr KN: Interventions to improve health outcomes for patients with low literacy. a systematic review. J Gen Intern Med 2005, 20(2):185-192.
• [38]Sudore RL, Schillinger D: Interventions to improve care for patients with limited health literacy. J Clin Outcomes Manag 2009, 16(1):20-29.
• [39]DeWalt DA, Broucksou KA, Hawk V, Brach C, Hink A, Rudd R, Callahan L: Developing and testing the health literacy universal precautions toolkit. Nurs Outlook 2011, 59(2):85-94.