Health literacy is a critical issue that is in danger of being overlooked when evaluating the needs of older workers, observes Brenda Schmidt, president of Diversity Wellness, Phoenix, Ariz. Although low health literacy can affect all populations, it is particularly a problem among those of modest financial means, many of whom are older adults or people with limited education or English proficiency, according to Health Literacy Practices in Primary Care Settings: Examples From the Field (Commonwealth Fund, Vol. 81, Jan. 11, 2008).
According to Health Literacy Fact Sheets distributed by the Center for Health Care Strategies, “health literacy is a constellation of skills that constitute the ability to perform basic reading and numerical tasks for functioning in the health care environment and acting on health care information” (www.chcs.org). Some experts add a working knowledge of disease processes, self-efficacy and motivation for political action to that definition.
Ms. Schmidt, whose company provides culturally appropriate, language-specific health improvement programs in the workplace, said research shows that health literacy declines after age 65. This is attributable, at least in part, to the sheer volume of information one is expected to absorb and confusion about to how to navigate the health system.
“It can be overwhelming and difficult for people to take away key points” from a health care encounter, Ms Schmidt said. Cultural considerations and attitudes about the medical profession often play a role in health literacy. It also is possible for an individual to have high literacy in their native language, but low literacy in English.
To be of greater assistance to those with lower levels of health literacy, Ms.Schmidt advises occupational health professionals to watch for warning signs such as missed appointments, “misplaced” eyeglasses, forms with errors or that have not be completely filled out, and indications from patients that they would prefer to take reading material home.
Diversity Wellness’ worksite-based approach incorporates health risk assessment and education for adults of all ages on topics such as stress management, nutrition and smoking cessation. Ms. Schmidt encourages older workers to obtain copies of their biometric test results and other laboratory findings so they can track their changes over time rather than rely exclusively on a medical professional to interpret them. She also recommends a booklet published by the National Institute on Aging called Talking to Your Doctor: A Guide for Older People, which is available in Spanish and English
(www.nia.nih.gov/HealthInformation).
Technology at Work
Experts say access to, and an understanding of, internet-based resources, also should be taken into consideration as part of health literacy in the aging population.
Many stakeholders are concerned that electronic health systems will benefit individuals and communities with greater resources and leave behind those with minimal technological skills and limited access. In addition, the majority of health websites are designed for people with a strong understanding of health information. However, the average American adult reads at an eighth-grade level, according to findings from an Institute of Medicine workshop on
Health Literacy, eHealth, and Communication: Putting the Consumer First, held in April 2009
Promising Practices
Clinicians for the Underserved conducted an online survey of primary care providers to acquire suggestions for effective healthy literacy approaches in their practices. The following five “promising practices” emerged:
1. A team effort: Each team member has an obligation to know if a patient is challenged by health illiteracy and to share this information, formally or informally, with other members.
2. Standardized communication tools: Clinicians who use methods such as Teach Back, Ask Me 3 or Motivational Interviewing find them effective at improving communication.
3. Personal approach: Approaches to techniques that help improve communication with patients include:
- Use of plain language, free of medical jargon;
- Sitting face-to-face with the patient;
- Use of simple diagrams or pictograms to illustrate explanations;
- Use of educational materials geared to low health literacy individuals.
4. Patient partnerships: Clinicians at some health facilities conduct goal-setting with their patients and collaborate to achieve those goals. The process includes patients’ agreement to work toward specific goals and formal mechanisms for verifying whether patients understand and are following their treatment plans.
5. Organizational commitment: Health literacy practices are most successful at healthcare facilities that have infused them as part of their operating philosophy, provided in-service training and new-employee orientation, and even participated in a research study on health literacy.
