Health Literacy: History
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Contributor:
Charity Ngoatle
,
Lina S. Hlahla
,
Mabitsela H. Mphasha
,
Tebogo M. Mothiba
,
Mahlapahlapana J. Themane

Health literacy is the intersection of general literacy, health, and healthcare, but it can also incorporate elements of other types of literacies to varying degrees. The notion of literacy surfaced from the fear that individuals would require more than general literacy skills to manage the complexities of health and health system issues. There is a substantial overlap between general literacy and health literacy. Therefore, general literacy alone may not be enough to live a healthy lifestyle, articulate the health systems and to prevent, manage and control diseases. The questions is: Does health literacy have an impact on adherence to diabetes mellitus treatment? This question is not only limited to diabetes mellitus.

  • health literacy
  • adherence
  • non-adherence
  • prescribed medication

1. Introduction

Health literacy is the intersection of general literacy, health, and healthcare, but it can also incorporate elements of the other types of literacy to various extents [1]. The belief that people require more than just general literacy skills to manage the complexity of health and health system issues gave rise to the concept of health literacy. There is a significant overlay between general literacy and health literacy. However, there are distinct health-specific demands in health literacy that differ from those in general literacy [1]. That is to say, having general literacy alone is insufficient if one wants to live a healthy lifestyle and be able to avoid, manage, and control diseases and illnesses. Numerous studies have shown that a lack of health literacy assessment results in healthcare professionals overestimating clients’ health literacy skills. As a result, only half of the clients with inadequate health literacy are identified [2]. Additionally, it was suggested that an accurate and effective method of determining a client’s health literacy should be in place to help nurses and other members of the healthcare team identify individuals who struggle to fully understand and follow instructions and information about their health [2].
Therefore, health literacy is divided into three levels: basic/functional health literacy, communicative/ interactive health literacy, and critical health literacy [3].

2. Basic/Functional Health

Functional health literacy is described as having adequate basic skills in reading and writing to function properly in everyday life [3]. As a result, functional health literacy is essential for accessing services and information needed to support a person’s health, such as reading medication-on-medication labels [3]. People living with diabetes need to follow their treatment regime, which includes lifestyle modification, following prescribed medication, and diet adherence. Treatment is defined as the management and care of a patient to fight a disease or disorder [4]. Prescribed medication is defined as the medication ordered by a licensed medical professional, typically a medical doctor [5]. On the other hand, non-adherence (which may be intentional—deciding not to follow treatment; or unintentional—unawareness of not following treatment) is the inability to follow medication or treatment proposals [6]. So, low health literacy in people living with diabetes mellitus can make it difficult to follow doctors’ instructions and take prescribed medication properly; however, medical information can be fully grasped when projected little by little, using simple words and avoiding the provision of more information than is needed at one time [7]. Now, diabetes mellitus is the general name for a variety of metabolic conditions with chronic hyperglycemia as their primary symptom [8].

3. Communicative/Interactive Health Literacy

Interactive health literacy refers to more sophisticated cognitive, literacy, and social abilities that can be used to actively participate in daily activities [3]. These skills are used to retrieve information and meaning from various forms of communication and apply new information to changing situations. The interactive health literacy approach improves people’s ability to act independently based on their knowledge [3]. Patients reported that communication with health and social care providers is frequently insufficient, according to a study conducted on barriers to medication adherence among rural women with hypertension [7]. As a result, it primarily causes patients to take their medications improperly [3]. Patients with poor health literacy would be less likely to understand and participate in programs for disease prevention and health promotion [4]. Compared to patients who have adequate health literacy, poor health literacy patients tend to require frequent hospitalizations [7].
Patients claimed to have confidence in their ability to take medications but confirmed a lack of understanding of the instructions for doing so [9]. Patients also mentioned several communication-related challenges to effective medication management and expressed a preference for medication instructions that were illustrated because they could help them with some of their problems [9].

4. Critical Health Literacy

Critical health literacy includes advanced cognitive skills that, when combined with social skills, can be used to seriously examine the information, as well as the use of that information to exert greater control over life events and situations [3]. As a result, health literacy extends beyond communication to the development of skills required to effect social change to promote health [3].
The following health literacy framework was developed based on these types of health literacy explanations (Table 1) [10].
Table 1. Health Literacy Framework.
Types of Health Literacy Nutbeam’s (2000)
Definitions		 Categories of Analysis
  • Functional/basic health literacy
 An individual’s aptitude for finding and understanding health information. The ability to recognize and form patterns of physical activity in daily life.
2.
Interactive/ communicative health literacy
 The capacity of an individual to apply health knowledge to various daily activities to achieve positive health outcomes. The ability to put into practice one’s understanding of how physical activity patterns are created, as well as the ability to plan and live a healthy lifestyle under the current conditions.
3.
Critical health literacy
 Having the capacity to act to change circumstances that affect one’s health and the health of others. This includes the capacity to address structural determinants of health and use the information to achieve maximum control. The ability to understand how social determinants affect physical activity ranks, to relate critically to recommendations for physical activity, and to use these abilities to improve one’s own and others’ quality of life by changing the status quo.
According to the health literacy framework, an individual should have health literacy knowledge and understanding [10]. However, the individual must also act accordingly to demonstrate health literacy knowledge. Finally, the individual should enhance their daily life and the lives of others by adopting a healthy lifestyle as advised to improve their present situation [10]. Teachers at older primary and secondary schools can effectively integrate health literacy development into classroom-based curriculum teaching according to learners’ stage of development [10].

5. The Significance of Health Literacy

Health literacy is vital to ensure access to care, self-care of chronic conditions, and maintenance of health and wellbeing; it is additionally essential to healthcare, mandating individuals play a greater role in decision making and management [11]. The Institute of Medicine (IOM) reports that 90 million Americans, likely half of the adult population in this country, lack the health literacy skills required to comprehend and act on health information and the health system [11]. Patients with diabetes mellitus misinterpret medication instructions on medication labels, which poses a medication safety and health literacy risk [12]. It was discovered that nearly half of patients receiving primary healthcare misread common dosage instructions on medication container labels [12].
Medication compliance is linked to health literacy. When compared to patients with sufficient health literacy, patients with low health literacy have been shown to have less knowledge about how to take their medications as prescribed [13]. It has been confirmed that the role of health literacy is significant and that it can be an important indicator of medication compliance in patients with diabetes mellitus [14].
As a result, the study suggests that health literacy should be improved to promote medication adherence in diabetes mellitus patients [14]. Educational programs for monitoring and increasing public awareness of health literacy should therefore be a major focus. These programs should also include implementation, an evaluation that takes into account public feedback, and ongoing consultation with the medical staff [14].
It is indicated that reading medication labels correctly is an essential component of managing and controlling diabetes among Malaysians with the disease [15]. The study also found that reading the dosage instructions did not always prevent participants from demonstrating a practical understanding of how to take prescribed medications [15]. While literate individuals can read, because they lack health literacy, they are unable to understand medication instructions [15]. Since it is crucial for patients to fully understand their medications, the study recommended that steps be taken to improve medication label literacy among diabetes patients. Continual patient education, patient awareness campaigns, and other strategies to help patients understand medication labeling need to be implemented [15].

6. The Consequences of Health Literacy

Medication non-adherence is widespread throughout the world and is regarded as one of the most serious public health issues [16]. Half of all chronic disease medications, including diabetes medications, are estimated to be taken incorrectly. Non-adherence has been linked to poorer treatment outcomes, disease symptom progression, and complications. It has been discovered that patients do not always take their medications as prescribed [17]. This leads to suboptimal quality of the desired outcome in terms of prescribed medication therapy, as well as medication-related challenges [17]. Additionally, it has been noted that up to 50% of adults have a tendency to misinterpret dosage directions and warnings found on medication labels, leaflets, and prescriptions [17]. This might be the cause of the patient’s failure to take their medication as directed [17]. The assumption made by healthcare professionals that patients can read medication instructions on labels, comprehend them, and respond appropriately is unsupported [17].
Non-adherence is also associated with increased healthcare usage and hospitalization [16]. This was also discovered in a study that revealed that the majority of diabetes mellitus patients had a knowledge gap regarding medication use during disease treatment [14]. This lack of knowledge has the potential to worsen the health of people with diabetes. As a result, there will be substantial growth in direct and indirect health costs [18]. Among diabetic patients, a critical concern is a lack of understanding of prescribed medications and medication labels [19]. The primary focus of the study was on basic medication knowledge and medication labels, which included information on dosages, duration, timing, indications, interactions, side effects, contraindications, and precautions [19]. Patients find it difficult to use the medications as desired when the instructions on the prescriptions and labels are unclear and unnecessarily complex, which results in non-adherence and could have negative health effects [19]. In a separate study, it was found that patients with poor functional health literacy had a higher likelihood of having poor glycemic control than other patients [20]. These results emphasize the need for clinical practice to address the issue of low health literacy [21]. This study indicates that good glycemic control in diabetes mellitus patients is compatible with adequate health literacy [21]. It has been reported that most diabetic patients are presently managed with the most effective available medications [20][21]. Nonetheless, the results from their study indicate a different outcome, wherein the anticipated blood sugar level could not be controlled and maintained effectively [20][21]. This outcome was due to poor adherence to the prescribed medication regimen and poor knowledge or practice of efficacious self-management strategies [20][21]. This reiterates the importance of instituting health literacy in diabetes mellitus patients.
Surprisingly, it has also been revealed that health professionals’ health illiteracy regarding medication prescription interpretation poses a significant challenge to society [22]. In truth, those who lead the healthcare system’s front lines lack literacy skills as well, so it is not just the patients who are impacted by poor health literacy [22]. All groups, including doctors, were observed to explain medication prescription instructions with a significant within-group disparity [22]. Additionally, there were differences in how the doctors, nurses, and healthcare consumers interpreted the prescription instructions across groups. No instruction was consistently followed, and a sizable number of patient and nurse interpretations led to potentially hazardous medication administration schedules [22]. The study also showed that some medical professionals, including nurses, were unaware of the likelihood of interpretation variability [22]. The study concluded that because health professionals may understand similar instructions differently, it is crucial to raise their level of awareness and to teach them about potential misinterpretation sources [22].

This entry is adapted from the peer-reviewed paper 10.3390/endocrines4010007

References

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