group.
23
Without careful implementation,
current policies to promote greater patient
participation in healthcare decisions may
exacerbate existing inequities by engaging
only those who are most literate and
confident in a healthcare setting, and
further alienating those least able to
navigate their way into the healthcare
system, interact successfully with
healthcare professionals, and understand
disease prevention and management
options.
WHAT INTERVENTIONS WORK?
Although more research is needed to
determine the nature of the situation in the
UK, the data from the 2003 national literacy
survey (Skills for Life) provide a good
indication of the likely scale of the problem
and its impact on health care in the UK.
Low health literacy is a real and significant
barrier to patient participation in health
care in England.
Individuals with undeveloped skills in
reading, oral communication, and
numeracy not only have less exposure to
health and medical information, but also
less developed skills to act upon the
information received. For these reasons,
strategies to promote health literacy will
remain inextricably tied to more general
strategies to promote literacy, numeracy,
and language skills in populations. A
recent review of more complex
interventions aimed at improving health
outcomes for people with limited literacy
identified only 15 trials; of which only one
was conducted on a UK population.
24
The
interventions studied were mostly focused
on health education and management for
patients, only two interventions were
directed at health professionals and only
one encompassed both. Very few focused
on clinical outcomes. These findings are in
line with an earlier systematic review
conducted in the US.
26
More
comprehensive interventions, aimed both
at improving patient knowledge and
empowerment as well as better
sensitisation of service providers to the
difficulties experienced by individuals with
low literacy are considered to be more
effective.
19
As a basic first step, health professionals
should consider the health literacy of their
patients while exploring their ‘ideas