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Did she say phlebotomy or lobotomy?

By Aoife O’ Driscoll

One in six adults in Ireland (521,550 people) finds reading and understanding everyday texts difficult, according to OECD research published by the CSO in 2012. This includes reading a leaflet, for example, or medicine instructions. In addition, a significant 40% of Irish people have limited health literacy according to the 2012 European Health Literacy Study.

This means that four out of ten people who use health services may find it difficult to understand and act on the health information and advice they receive.

Irish Health Literacy Research (2015) shows that 45% of people surveyed were unable to define the term “prognosis”. A 2014 review, carried out by the Royal College of General Practitioners in the UK, found that patients usually retain about half of the information they receive in a consultation with their healthcare professional. Only half of the information that they do remember is generally correct.

Health literacy and numeracy is about the healthcare provider communicating health information clearly and the patient understanding this information correctly. This is crucial for people’s health and wellbeing. The more effectively that people can act upon health information, the better their health outcomes will be.

Health numeracy is the ability to understand, use and act on numerical information. Most health information requires us to use basic numbers and calculations.

We are, for example, expected to manage our medication by reading and/or hearing instructions, understanding them, and working out doses. According to the OECD research, one in four adults in Ireland has difficulties in real-world maths – from simple addition and subtraction to the calculation of averages. A disturbing 17% of people surveyed in the 2015 research said they had taken the wrong amount of medication on at least one occasion.

There are many reasons why people have difficulties with health information. There are factors such as literacy, numeracy, needs, age, language, disability and culture. Specialised medical language used by healthcare professionals when speaking to their patients is another factor. People are often not familiar with these medical terms and it can be embarrassing to ask the doctor to explain them in everyday language. A further factor is that it is difficult to take in information properly when receiving worrying news about our health.

Medical jargon and emotional stress effect our health literacy and we could leave a consultation unclear about both our condition and treatment.

Promoting good health literacy and numeracy practices means that we can make sound health decisions at home and in the community. We can give informed consent to treatment and follow dosage instructions. We can understand how to live with chronic health conditions. We have the skills and confidence to ask questions, and we can navigate healthcare systems effectively. This is in everybody’s interests.

A Crystal Clear quality mark has just been launched to respond to this issue. This is the first ever such quality mark and has been developed by the National Adult Literacy Agency, along with the Irish Pharmacy Union, the Irish College of General Practitioners, and MSD (a pharmaceutical company). A Crystal Clear Pharmacy or General Practice delivers a quality service that takes account of possible literacy and numeracy needs of patients and consistently improves upon the services they provide.

Getting the Crystal Clear quality mark also recognises that the service regularly evaluates and improves its health literacy practices. An online audit tool has been developed to assess the health literacy and numeracy practices of pharmacies and general practices (www.nala.ie/crystalclear).

Healthcare providers need to take steps to communicate in ways that all their patients and patients can understand. They should think about the language they use when talking to patients and try to explain things in everyday language. When they talk about medication, they shouldn’t assume the patient will understand quantitative concepts or are familiar with the measurements involved.

They should use teach-back, a way to assess and confirm that people understand what they have been told, by asking them to repeat back the key information in their own words and encouraging  patients to ask any questions that they may have, after the repetition. •

Aoife O’Driscoll is Policy Officer with the National Adult Literacy Agency