Health Literacy Essay Example

  • Category:
  • Document type:
  • Level:
  • Page:
  • Words:


Health Literacy

Health literacy has been recognized as a critical factor that influences patient engagement in the management of their disease (Coulter & Ellins, 2007). The term health literacy denotes the degree to which an individual has the ability to access, evaluate and accurately interpret health information. According to Eckman, Wise, Leonard et al.(2012), health literacy is more than just retrieval, evaluation, and interpretation of health data; rather it is a crucial empowerment approach to increase individual’s control over their own health outcomes ( Eckman, et al., 2012). Further, Eckman, Wise, Leonard et al. (2012) also defined health literacy as the skills and competencies that individuals cultivate in order to reduce health risks, make informed health choices, and augment their quality of life.

Extensive research shows that individuals with impaired health literacy levels exhibit less knowledge regarding diseases, demonstrate declined rates of preventative care, have lesser adherence to medical directives, are less efficient in self-management, and are often unable to effectively use the healthcare system (Montgomery & Little, 2011). Furthermore, insufficient health literacy levels are also linked to deteriorated physical and mental health as well as increased limitations in routine ADLs. Conversely, a higher level of health literacy is also an empowering personal asset, whereby it gives patients and their kin, the ability to participate confidently as self-determining agents within the health care system and adopt a more active role in defining and identifying their healthcare needs (Peerson & Saunders , 2009).

Impaired health literacy levels are predominantly prevalent amongst older populations, minorities, individuals with low educational attainment levels, as well as chronic disease patients. This paper discusses health literacy in patients with chronic respiratory problems as evidenced in a case study involving a home visiting nurse caring for various elderly patients receiving care from numerous health practitioners. The home care nurse discovers that a majority of her clients are confused regarding their treatments. The current paper explores the promotion of health literacy among elderly patients with chronic respiratory issues. Also discussed herein, is how the nurse could promote health literacy using the empowerment approach among elderly patients with chronic respiratory problems.

Health Literacy in the Elderly

As indicated earlier, health literacy has a critical role in the self-management of chronic respiratory diseases. Impaired health literacy is prevalent among the elderly; older Australians who represent approximately more that 12% of the Australian population (Berkman, Sheridan, Donahue, & Halpern, 2011). A majority of patients with chronic respiratory problems are in between the ages of 55 – 75, and studies show that elderly individuals at the age of 65 are viewed as a vulnerable group due to poor literacy levels (Canadian Council on Learning (CCL), 2008). According to studies, limited or impaired health literacy among older individuals often associated with sensory and cognitive ability, degree and level of education as well as the time passed since formal education. Additionally, other factors that explain the high incidence of declined health literacy in elderly people include conditions such as depression, cognitive decline and dementia (Wolf , Gazmararian , & Baker, 2007).

Notably, poor reading skills have a very critical impact on the elderly patients’ ability to comprehend healthcare information. Elderly patients with chronic respiratory conditions such as COPD (Chronic Obstructive Pulmonary Disease) are particularly vulnerable since these patients characteristically have more complex treatment routines, demanding numerous consultations frequently with different practitioners. In addition to a limitation of the ability to remember information, patients with abridged health literacy may inherently have an increased difficulty in understanding medical information.

Consequently, such patients are less likely to adhere to treatment therapies because of misunderstandings (Gooneratne, Patel, & Corcoran, 2010). In such cases, patients forget what is said during medical consultation as soon as it ends, a characteristic which increases with cognitive impairment typical in elderly patients. According to a recent study of diabetics with reduced health literacy, such patients had problems recalling new concepts and required more clear explanations from their physicians. Moreover, extensive studies conducted on patients with hypoxemia have demonstrated significant impairments in abstract reasoning, co-ordination and memory of simple motor activities affect their compliance with treatment (Roberts, Ghiassi, & Partridge, 2008).

Further, most elderly patients with chronic respiratory issues are prone to depression arising from an increased sense of loss and hopelessness, perceiving that their conditions are untreatable or “self-inflicted”. According to literature, elderly patients with COPD may feel guilty or depressed regarding their condition which impairs their decision making (Roberts, Ghiassi, & Partridge, 2008).

Issues Related to People Having Chronic Conditions i.e. COPD

Limited health literacy often leads to a declined ability to efficiently self-manage health, access and use health services, comprehend presented and relevant medical data and make knowledgeable health-related decisions. A common outcome of impaired literacy levels among elderly patients with COPD is confusion regarding treatment instructions, leading to non-adherence to treatment. Accordingly, practitioners and care providers in the health sector are required to promote health literacy among such patients. Indeed, enhanced health literacy contributes to more well-informed medical choices, declined health risks, improved prevention and wellness, superior access and use of the health care system, enhanced patient safety, improved patient care, less health inequities, and advanced quality of life (McDonald, Higgins , Simpson, & Gibson , 2011).

According to Mitchell and Begoray (2010), the main goal of promoting health literacy among older patients, is to advance individual health outcomes by augmenting skills and competences that result in increased and more efficient self-engagement and participation in the management of a patient’s illness (Mitchell & Begoray, 2010). As such, interventions targeted at improving health literacy among elderly patients with chronic respiratory disorders are implemented at the patient, practice, and health care provider, organization or system levels. Research evidence suggests that a multi- faceted, patient-centered, approaches are more appropriate in promoting health literacy among elderly patients (Jung , Pickard , Salmon , Bartle , & Lee , 2009.

Such approaches tend to focus on improving compliance through interventions and educational programs. Literature shows that teaching self-management strategy to patients with asthma such as disease education, checking inhaler techniques and reinforcement, and self-monitoring; have a significant impact on improving patient outcomes. In another study with COPD patients, teaching self-management strategies resulted in a reduction in hospital use among patients, unscheduled primary care, declined hospital admissions with exacerbations and eventually reduced mortality (Woo, Chau, & Mak, 2013). The self-management approach encompassed education, support, home exercise program, case management and an action plan detailing the use of steroid tablets and antibiotics. Indeed, the use of an action plan among elderly COPD patients increases their ability to recognize severe exacerbation and increase the use of antibiotics and oral steroids. According to these studies, giving patients personalized advice and explaining medication to patients alongside other interventions including case management and pulmonary rehabilitation improves patient outcomes (Mak, Woo, Bowling, Wong, & Chau, 2011). Nevertheless, this advice should be customized further, to guarantee comprehensibility by the patient and their care givers. This may be achieved through the usage of pictorial aids within the action plans and use of other information dissemination formats including DVDs, to emphasize vital medical data for patients to carry home (Lee , Arozullah , Cho, Crittenden, & Vicence, 2009).

Another objective of health literacy promotion approaches is to improve consultations with patients to advance patient recall among patients with low levels of functional health literacy. According to Roberts, Ghiassi and Partridge (2008) elderly patients recall approximately less than 50% of what they are told during consultations. In patients with low levels of health literacy they will also exhibit problems in reading medication labels, comprehending appointment or reading materials and understanding the risk. These patients will also exhibit problems in naming and describing their treatments therapies. Therefore, to intervene in this case, the use of written and verbal communication is an effective and efficient way of promoting patient understanding. This may include the usage of consultation items such as decision aids, leaflets, videos and pictograms, which improve the recall of medical instruction (Roberts, Ghiassi, & Partridge, 2008).

Empowering Patients with COPD so that they can have a positive response to interventions

According to the Nutbeam Health Literacy Model, health literacy occurs in three sequential levels namely; functional literacy level, interactive literacy level and the critical literacy level. At the functional literacy level, patients are unable to sufficiently adhere to their medical care instructions as described in their written materials and informational brochures. Impairment in functional health literacy is a key barrier to educating elderly respiratory disorder patients. Accordingly, to develop health literacy at this level, the nurse should educate her patients using the multifaceted approaches described earlier, including pictograms, multimedia, visual aids and pictograms. These items will help the patients to improve their recall ability and therefore eliminate confusion in their treatments (Nutbeam, 2008).

The second stage of the Nutbeam Model is the interactive literacy level where the nurse will focus on developing advanced cognitive skills and ability to function socially. Such skills allow older individuals to extract and apply information derived from numerous forms of communication, to develop personal capacity and act on advice from significant others. A major factor in managing patients with chronic respiratory problems is the ability to manage symptoms and learn coping strategies. Consequently, the nurse should develop patient peer networks and support groups where the patients can acquire essential health information and coping strategies through sharing experiences with each other. The nurse could act as a peer leader in these meetings and assist the patients augment their self-efficacy, gain confidence and understanding of their treatment therapies (Laurence , Olivier , & Crotty, 2011).

The last stage in the Nutbeam Model is critical health literacy which echoes the development of advanced cognitive skills that are focused on supporting both individual and social action. At this point, the nurse should design and conduct health education aimed at developing individual and societal capacity to sustain healthy lifestyle and medical choices. In this case, the nurse could involve family members and immediate neighbors and educate them on the treatment therapies and the support they should provide for the patients. According to Montgomery and Little (2011) age is a limitation in the leaning process as this group of individuals due to declined cognitive abilities and a progressive inability to retain and process extensive information unlike the young. Hence, involving family members in the patient care process establishes ‘an information reservoir’ which ensure that much information is retained and is readily accessible when required. Nutbeam (2008) stated that empowerment is achieved through the creation of collaborative and critical health literacy abilities (Nutbeam, 2008). However, in order to empower patients, the nurse should build a solid foundation of functional literacy which is reinforced by a supportive and educated provider network. In this regard, the nurse could apply a collaborative initiative among the practitioners involved in her patient’s care to further their literacy skills.


Eckman, M., Wise, R., Leonard, A., Dixon, E., Burrows, C., Khan, F., et al. (2012). Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases. International Journal for Communication in HealthCare,Volume 87, Issue 2 , 143-151.

Berkman, N., Sheridan, S., Donahue, K., & Halpern, D. (2011). Evidence Suggesting That a Chronic Disease Self-Managemen Program Can Improve Health Status While Reducing Hospitalization A Randomized Trial. MEDICAL CARE Volume 37, Number 1,, 5-14.

Bourbeau , J., & van der Palen , J. (2009). Promoting effective self-management programmes to improve COPD. Eur Respir J.;33(3), 461–463.

Canadian Council on Learning (CCL). (2008). Health literacy in Canada: A healthy understanding. Ottawa: Canadian Council on Learning (CCL).

Coulter, A., & Ellins, J. (2007). Effectiveness of strategies for informing educating, and involving patients. British Medical Journal, 335, 24–27.

Gooneratne, N., Patel, N., & Corcoran, A. (2010). Chronic Obstructive Pulmonary Disease Diagnosis and Management in Older Adults. J Am Geriatr Soc.;58(6), 1153–1162.

Jung , E., Pickard , A., Salmon , J., Bartle , B., & Lee , T. (2009). edication adherence and persistence in the last year of life in COPD patients. Respir Med.;103(4), 525–534.

Laurence , L., Olivier , B., & Crotty, K. ( 2011). E-health Applications and Services for Patient Empowerment: Directions for Best Practices in The Netherlands. Ann Intern Med.;155, 97-107.

Lee , S., Arozullah , A., Cho, Y., Crittenden, K., & Vicence, D. (2009). Health literacy,social support, and health status among older adults. Educational Gerontology;35., 191-201.

Mak, B., Woo, J., Bowling, A., Wong, F., & Chau, P. (2011). Health care prioritization in ageing societies: Influence of age, education, health literacy and culture. Health care prioritization in ageing societies Vol 100,Issue 2-3, 2-30.

McDonald, V., Higgins , I., Simpson, J., & Gibson , P. (2011). The importance of clinical management problems in older people with COPD and asthma: do patients and physicians agree? Prim Care Respir J.;20(4), 389–395.

Mitchell, B., & Begoray, D. (2010). Electronic Personal Health Records that Promote Self-management in Chronic Illness. OJIN: The Online Journal of Issues in Nursing 15(3) .

Montgomery, K., & Little, M. (2011). Enriching patient-centred care in serious illness: A focus on patients’ experiences of agency. Milbank Quarterly,89, 381-398.

Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67, 2072–2078.

Peerson, A., & Saunders , M. (2009). Health literacy revisited: what do we mean and why does it matter? . Health Promotion International, 24 (3), 285-296.

Roberts, N., Ghiassi, R., & Partridge, M. (2008). Health literacy in COPD. Int J Chron Obstruct Pulmon Dis. 3(4), 499-507.

Wolf , M., Gazmararian , J., & Baker, D. ( 2007;). Health literacy and health risk behaviors among older adults. Am J Prev Med.;32, 19-24.

Woo, J., Chau, P., & Mak, B. (2013). Health Literacy Regarding Aging Issues. International Perspectives on Aging Volume 5, 157-181.