NALA Health and Literacy Research Report Launch 13th September 2002

13 Sep 2002

The Dental Health Foundation welcomes the launch of the first ever Health and Literacy Research report published in Ireland, on Friday 13th September 2002. The Dental Health Foundation contributed to the implementation of this research through participation on the steering committee, advising and guiding the research initiative. The following is an extract from the report and the full report can be sourced through the National Adult Literacy Agency Offices, 76 Gardiner Street, Dublin, 1. Tel: 01-8554332. website: http://www.nala.ieForewordThis health literacy research report marks the first time literacy has significantly entered the health debate in Ireland. Adult literacy learners have been given a voice. Up to this point in our campaigning work we have had to rely on anecdotal stories about how literacy impacted on people’s health encounters and recount international findings. There is a serious lack of Irish research data on this subject available to policy makers. However the Irish results of the 1997 International Adult Literacy Survey (IALS) found that 25% of the population tested could not fully understand the directions on a popular headache packet. This led to the first National Adult Literacy Strategy and a broad recognition that there is a significant minority of Irish adults with literacy problems. The publication of the National Health Promotion Strategy in 2000 which clearly identified low literacy skills as a barrier to good health, illustrates this point:“poor literacy skills ….limits access to health information and health service.” (p.20)To ensure the strategic effectiveness of the National Health Promotion Strategy 2000-2005 NALA recognised that policy-oriented research was urgently required. We approached the Department of Health and Children in 2000 arguing there was a need for a co-ordinated research programme of study into health and literacy in Ireland. We wanted to establish the precise health issues and needs of low literacy populations and inform strategic policy making.This research shows that people have struggled with essential health information, consent forms, have not fully understood procedures, found signage confusing and did not feel capable of taking part in decision making. Fear is a big barrier to communication. True patient education is difficult to achieve among people with low literacy skills when there is such a reliance on the written word. This report also highlights examples of people finding it difficult and in some cases impossible to navigate their way around the health system. To quote one USA researcher: “ Functional literacy is not just about your health, but about how to get to your appointment.” This research illustrates that health literacy means more than just reading information. It involves taking part in decision making and understanding options. Patients need time to review material. Health practitioners need to understand that one leaflet cannot accommodate the whole patient population. Health practitioners were surprised at the extent of the literacy problem in Ireland and the fact that literacy could be such a significant barrier. We are not surprised that adults do not draw attention to their literacy deficits. We know that people with literacy difficulties become very adept at hiding their difficulties. This means that it will not always be apparent to health practitioners that instructions and advice are not being adequately relayed to low literacy patients.We hope that this research project will play a part in addressing the health literacy issue. We hope it will focus policy makers and bring literacy and health practitioners together. This is a very exciting time in the Irish medical service. The new health strategy emphasises the integration between primary care and specialist services in the community. There is a strong focus on providing care in the community. Numerous proposals are made including improved linkages within and between health services. Literacy and health practitioners, especially Health Promotion practitioners could widen the debate on health and communication. The Health Promotion Unit in the Department of Health and Children financed this two-part project and we would like to acknowledge their initiative. The next step in this project is to produce literacy friendly booklets. We will be guided by this research and hope it will be a meaningful piece of work for Health Promotion and VEC Adult Literacy Organisers. Individual health practitioners in different health care settings have been trying to tackle this issue in isolation with no guidance from management. The VEC adult literacy service has to give healthcare workers practical help and support. Through our strategic plan 2001-2006 health initiatives we will continue to develop health literacy policies and resources. Interviews with the 78 adults point to the fact that literacy is not an isolated problem but usually part of a range of social problems. This shows that literacy needs to be viewed and tackled from a wide perspective. While we were particularly interested in how weak literacy skills can be a barrier to good health promotion, discussions with interviewees opened up wider debates. Health literacy is a complex problem that requires a range of responses, hence our range of recommended strategic actions.The Health Strategy (2001) emphasises the need for a strategic change around how the health system is experienced by the public. We hope this report will contribute to this change.