Health Literacy in Inner London
Dr Dirk Pilat
"The doctor at the hospital told me that I have stage 2 kidney disease! Will I have to cancel my trip to Malaga, and so do I need dialysis?"
I am moderately sure that every general practitioner up and down the country has heard something similar from a patient and shares with me the belief that insufficient health literacy is one of the banes of our professional life.
I work in a large practice in Tower Hamlets, one of the most deprived areas in the United Kingdom, and the lack of access with face to face appointments with GP has been the biggest concern for our patients for the last fifteen years, although our appointment system has been constantly refined and we have more appointments than ever.
Reflecting on a typical day at my surgery, it is easy to come to the conclusion that a significant amount of these appointments could have been avoided, were it not for a lack of functional health literacy within the area. Whether it is the reassurance of a patient after a particularly complex clinic letter, a soothing explanation of a frightening article on statins in a national paper, the fifteenth attempt at demonstrating the difference between viruses and bacteria, and the importance of self-care during flu like illnesses or sore throats, improved health literacy is important. Improved health literacy would not only change the health-seeking behaviour within our practice area and resolve our access issues, but also significantly reduce our local A & E patient load and save our clinical commissioning group oodles of money.
Critical health literacy, noted by Nutbeam as 'directing the individual towards improving individual and community capacity to act on social and economic determinants of health' is also in short supply. Childhood and adult obesity, malnutrition and lack of exercise is unfortunately endemic and lack of knowledge of physical activity guidelines for children and negativity towards physical education at school among girls potentially hinders attempts at healthy living. This results in typical consultations which involve a pair of concerned parents, worried about the lack of appetite of their prodigy during traditional mealtimes. Examination of the child will invariably find a little person happily munching away on a bag of Wotsits. 'It is the only thing he/she will eat doctor.'
Here at Bromley-by-Bow Health partners (BBBHP) we have started, in cooperation with UCL Partners, to address these issues: parents of children under the age of five who were frequently reappearing at St Andrew's Health Centre (one of three surgeries run by BBBHP), struggling with the management of self-limiting childhood problems, were approached and enrolled in a programme. This programme would provide knowledge and skills to ensure they were more confident to manage their children's health at home and when to seek further help. After the first cohort of this programme we began to see outstanding results. Shy and reserved parents began to open up and share their own experiences; parents relying on packet food began introducing fresh vegetables and home cooked meals; parents attending for coughs and colds were apt with going to the pharmacy and getting advice there, with a significant increase in access to the Pharmacy First Scheme.
Evaluation demonstrated that parents who had attended the sessions had a reduced attendance not only for GPs, but for Out of Hours GPs and A & E as well. In addition to our own attempts at improving health literacy, it is encouraging that NHS England has invested a significant amount of money to improve patients' basic online skills to boost health literacy.
A recent report from a RCGP-led health literacy workshop calls for a five-year plan to battle the issues raised by low health literacy in England. However, I have the sneaky feeling that a significant amount of the forty to fifty appointments I offer my patients on my clinical days will continue to be reserved by Wotsits, viruses and the worried well.
This is the second of four articles focusing on health literacy in general practice. Click here to view the three other articles.
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Nutbeam, D. (2000) Health literacy as a public health goal: a challenge for contemporary health education and communication strategies in the 21 century. Health Promotion International, 15(3), 259-267.
Rawlins, E., Baker, G., Maynard, M., & Harding, S. (2012) Perceptions of healthy eating and physical activity in an ethnically diverse sample of young children and their parents: the DEAL prevention of obesity study. Journal of Human Nutrition and Dietetics, 36(2), 132-144.
Rowlands, G., Protheroe, J., Price, H., Gann, B., & Rafi, I. (2004) Health Literacy. London: Royal College of General Practitioners.
Self Care Forum. (2004). DIY Health: A co-produced health education delivery module to empower parents in managing children's health. London: Self Care Forum.