Health Literacy in Canada Dr. Sandra Vamos University of Victoria Health Communication within the Reception of Migrants in Europe: Towards Joint Recommendations Conference Malmo, Sweden June 3-4, 2014

Face of Health Literacy in Canada  “Six in 10 Canadian adults do not have the skills needed to adequately manage their health and health-care needs.” In British Columbia:    

Seniors – 78.9% have low levels of health literacy Immigrants – 71.9%... Not employed – 67.9%... Aboriginal people – 66.3%...

NB: Data from 2003 IALSS data

* One out of 5 people in Canada’s population is foreign-borne (Statistics Canada, 2014)

Foreign-borne Population as Proportion of Total Population, G8 Countries and Australia, 2011

Sources: Organization for Economic Cooperation and Development, International Migration Outlook 2012, OECD Publishing, 2012, and Statistics Canada , National Household Survey, 2011

Real-life Health Literacy Challenges

Outline  What is health literacy and why is it important?  What is the Pan-Canadian Health Literacy Strategy?

 What is the Intersectoral Approach to Improving Health Literacy for Canadians?  What are recent examples of health literacy efforts?  What are the important skills and competencies health educators/communicators need to work with groups with lower health literacy levels?

Canada’s Health Literacy Vision Statement “All people in Canada have the capacity, opportunities and

support they need to obtain and use health information effectively, to act as informed partners in the care of themselves their families and communities, and to manage interactions in a variety of settings that affect health and well-being.” - Canadian Expert Panel on Health Literacy, p. 3, 2008

What is Health Literacy in Canada

“Health Literacy is the ability to access, understand,, evaluate,, and communicate information as a way to promote, maintain and improve health in a variety of settings across the lifecourse.”

(B.C. Health Literacy Research Team, Canadian Expert Panel on Health Literacy, Rootman & Gordon-El-Bihbety, 2008)

Health Literacy Domains in Everyday Practice Access

Understand

Evaluate

Communicate

Young Families

…information from local resources about child health and safety …a parent support group

…how much medication to give a feverish child ….how to prepare infant formula following label instructions

…safety guidelines for different types of infant car seats …the nutrition panel on cracker boxes to determine which is lower in saturated fat

…with teachers about the school lunch policy ….with policy makers about the need for baby friendly public places

Retirees/ Older Persons

…on-line medical information about stroke symptoms …caregiver support groups

…doctor’s explanation of treatment options for pain surgery …how many grams of carbohydrate are in a box of cookies marketed to diabetics

…information from the internet about alcohol and heart disease risk …cost of local physical activity programs

…with a doctor about blood pressure control …with a dietitian about the fibre content of breakfast cereals

Immigrants/ Refugees

…a health centre using the telephone directory …information about local after school programs

…directions for completing a medical form …a poster promoting learning programs for new Canadians

…advice given about use of sunscreen and vit D needs …conflicting messages about use of over-the- counter cold medications

…with neighbours about recreation programs for teenagers …with a pharmacist about potential drug interactions

(Murphy, Heath, Gillis, & Gammon, 2010)

A Health Literacy Model = A Communication Tool Individuals

Family/

Intervention Agents

Friends

Education System

Individual Barriers/Enablers

Individuals

Health System

Workplace

HEALTH LITERACY

Intermediate Outcomes

Long-term Outcomes

Short-Term Outcomes Government

Health Contexts

Professional/Vol untary Organization

Media

System Barriers/Enablers

Adapted Kwan, Frankish , Rootman, 2006.

Why is Health Literacy Important 1.

Large numbers of people are affected

2. Related to poorer health outcomes and health behaviours 3. Related to increasing rates of chronic disease 4. Correlation to higher health care costs 5. Related to health information demands 6. Provides a concrete approach to address social determinants/inequities (8th European Health Policy Forum, Bad Gastein, 2005; Expert Panel on Health Literacy, 2008; Mitic & Rootman, 2012)

Health Literacy is Everywhere https://www.youtube.com/watch?v=_d-dtYTpdCw

The Canadian Context  Health literacy in Canada has been anchored in health promotion efforts and not driven by the medical system  Pockets of innovative HL programs, initiatives and activities across Canada  No governmental policies specifically directed at health literacy at any level of government in Canada  Stronger research in relation to health literacy has been evolving in Canada  Little private sector engagement

Milestones in Canadian Health Literacy Movement 1989 1994 2000 2004 2006

• Ontario Public Health Association Project on Literacy and Health • Canadian Public Health Association Literacy and Health Program • First National Conference on Literacy and Health • Second National Conference on Literacy and Health • Canadian Council on Learning Research and Reports • Canadian Expert Panel on Health Literacy Report

2008 • Calgary Institute and Charter on Health Literacy 2012

• Inter-sectoral Approach to Improve Health Literacy for Canadians: A Discussion Paper

Components of the Pan-Canadian Health Literacy Strategy 1.

Improve Health Literacy in Canada

2.

Increase Public Awareness

3.

Change Professional Education

4.

Improve Health Communications

5.

Move to Integrated Interventions

6.

Do the Research

7.

Ensure Program Funding and Evaluation

8.

Develop Capacity

9.

Implement the Strategy

2. Increase Public Awareness 2.1 Develop and undertake a coordinated multi-media campaign targeting the public and specific audiences e.g. health service providers, educators

2.2 Engage the corporate sector in promoting health literacy

2.3 Engage policy and decision makers in promoting health literacy

2.4 Align the Health Literacy Strategy with other national strategies

2.5 Integrate health literacy into curricula from primary and secondary education through to adult education

3. Change Professional Education 3.1 Make health literacy a mandatory component of service provider curricula and professional continuing education

3.2 Make proficiency in health literacy a requirement for professional registration and certification

3.3 Investigate alternative service delivery structures for patient/consumer communications (e.g., use of nurse practitioners, health educators, health literacy trainers etc.)

4. Improve Health Communications 4.1 Develop policy on use of plain/clear language and visual symbols in health communications

4.2 Develop guidelines and prototypes for health communications and interactions, including the use of multi media formats

4.3 Undertake assessments/audits of accessibility of service provision systems and institutions

4.4 Ensure access for people who lack fluency in English or French

4.5 Promote Telehealth models

8. Develop Capacity 8.1 Provide long-term funding for program sustainability 8.2 Create a national clearinghouse on health literacy information 8.3 Support the development of locally appropriate and adequate community supports and networks 8.4 Promote appropriate skills and knowledge on the part of providers of services in health, education, community and social

service sectors

An Intersectoral Approach to Improving Health Literacy for Canadians Vision: A health literacy Canada in which all people in Canada can access, understand, evaluate and use health information and services that can guide them and others in making informed decisions to enhance their health and well-being. Mission: To develop, implement and evaluate an approach that will support, coordinate and build health literacy capacity in Canada.

. Raise Awareness & Build Capacity Develop Knowledge

Build Infrastructure & Partnerships

Improved Health Literacy

(Mitic & Rootman, 2012)

Sample Health Literacy Activities Governments

Knowledge Development Raise Awareness & Build Capacity Build Infrastructure & Partnerships

Health Services

Education Sector

Workplace & Businesses

Community Organizations

Some Recent Examples of Canadian Health Literacy Initiatives  Health Literacy Scan Project  Health Literacy Examples in the Field Project  Learning for Health: Health Literacy Embedded Learning Demonstration Project  Health Canada Nutrition Labelling Project  Public Health Association of British Columbia (PHABC) Summer School  Undergraduate Health Literacy On-line Course (UVic)  The Play Exchange

 Online Health Literacy Modules for Public Health Professionals o Office of Public Health Capacity Development (Federal Government) o Canadian Medical Association (CMA)

Spotlight #1: Health Literacy Scan The purpose of the scan was to address questions of: 1)

What examples exist of noteworthy health-literacy activities at a Federal or national level in Canada and a set of comparable countries?

2) What have been the successes, areas of innovation, and challenges of those activities? 3) What do you see as the emerging opportunities and responsibilities for your division, agency or organization to address at this time in the area of health literacy?

Key Findings: Types of Health Literacy Initiatives in Canada Capacity Building / Awareness Raising • Training / educating the public / patients

• Educating health professionals • Working with vulnerable groups • Producing tailored, targeted programs, reports, and other materials • Utilizing social media sites for communication

Knowledge Development • Health literacy definition and concept development

• Measurement of health literacy levels • Identification of best practices by research / demonstration projects

Infrastructure Building & Partnerships • Organizing cross-agency and cross-sectoral collaboration

• Developing supports to inform policies, regulations, and standards for HL work • Requests for additional resources & positions for health literacy work (Frankish et al., 2011)

Spotlight #2: Canadian Health Literacy in Practice Project YT •CCDPC Diabetes Initiative

NWT •CCDPC Breast Health & Healthy Living Project

NU •GN Healthy Foods Program •Nunavut Career Health Camps

NFLD •CCDPC Peer Navigation for Women’s Cancers

BC •Health Literacy Collaborative Prototype •“Health Literacy Kits” for Adult ESL Learners •Healthy Literacy Library Partnership •Nutrition for You •Mental Health & Substance Use Resource Centre •Healthy Living Toolkits •Eating Disorders •Aboriginal Health Literacy •Aboriginal & Community Literacy

AB SK •Career & Life MB Management •Aboriginal Grandmothe •“It’s Safe Program r& Children to Ask” •Health Care ON Support (Manitoba Providers & •Cultural Nursing Education Network Institute of Staff Training •Healthy Smiles •“Breast Patient •Health Info •Health Care Providers & Low Friends” Safety) Resource Literacy Learners •ESL for Centres •“Ask Me 3” Older Adults •Chinese Seniors & Chronic Obstructive Pulmonary Disease • Seniors’ Aboriginal Children’s Literacy • Measuring Health Literacy

QC •Lire-ImagineRead (Montreal NB Children’s •“C’est quoi Hospital) ton truc?” • Breast Health Cancer Capsules Navigation Kit •Adult Learners

NS •Adult Literacy & Health Partners in Practice

(Frankish et al., 2012; CPHA, 2014 )

Approaches and Lessons Learned from Noteworthy Health Literacy Efforts  Establishment of intersectoral teams  Highly trained teams, volunteers, peer-navigators, and advocates

 Presence of strategic leadership and/or a champion-based model  Use of evidence-base, theory, and/or data to inform the work  Existence of activities in multiple settings using different delivery channels  Simple, easy-to-understand action steps and change ideas  Significance to daily life, local culture, and heritage  Opportunities with technology, social media, and/or media outlets

Spotlight #3: Public Health Association of British Columbia Summer School  An annual 4-day provincial multi-site opportunity connected via video-teleconferencing technology for public health professional workforce development.

 The goal is to build awareness, capacity, understanding and skills for promoting and protecting positive well-being by addressing health challenges and using evidence-informed health promoting mechanisms and implementation strategies related to health literacy, literacy and provincial health issues.

Spotlight #4: Health Literacy Course

Core Competencies for Public Health in Canada 1. Public health sciences 2. Assessment and analysis 3. Policy and program planning, implementation and evaluation 4. Partnerships, collaboration and advocacy 5. Diversity and inclusiveness 6. Communication 7. Leadership (Public Health Agency of Canada, 2008)

Seven Areas of Responsibilities for Health Educators, US, 2010 Areas of Responsibility

HLTH 360: Health Literacy & Systems Navigation

I. Assess Needs, Assets & Capacity for Health Education II. Plan Health Education III. Implement Health Education

 Assignment #1- Applying Health Literacy Concepts to a Community Health Program (Group)

IV. Conduct Evaluation & Research Related to Health Education

 Assignment #2 -Applying the Intersectoral Approach for Improving Health Literacy to a Target Group (Term Paper)

V. Administer & Manage Health Education VI. Serve as a Health Education Resource Person

VII. Communicate & Advocate for Health & Health Education

Health Courses XXXX: International Health Education

 School health education lessons and strategies implemented in German school system in collaboration with German university students  Peer-review journal publication with other international students on crosscultural health comparisons

 Course learning activities (LAs) to  Knowledge broker to obtain and disseminate tools and collaborators/stakeholders to approaches used to analyze health disseminate national healthliteracy-related barriers and enablers related information during to healthcare access and navigation to International site visits better support and serve patients, staff and consumers.  Participation in weekly course  Oral presentation via learning activities (LAs) and online international course and discussion forums while building conference health literacy and plain language skills  Assignment #3 -Health Literacy Environment Review (Naturalistic Observation and Student Video Presentation)

XXXX: Foundations of Health Promotion & Prevention

eTools and Training for Health Professionals

Guides to Make Your Health Message Clear and Understandable

(CDC, 2009; McMaster University, 2008)

Tips on How to Be a Better Health Communicator  Facts about clear health communication  Tips for clear health communication     

Creating easy-to-read content Planning easy-to-read docs Designing easy-to-read docs Creating easy-to-read docs Writing easy-to-read docs

 Common managed care terms and suggested alternatives  Plain language word list (http://www.healthresearchforaction.org)

Spotlight #5: The Play Exchange  Canada’s first highprofile competition to seek out leading edge healthy living ideas from all segments of society  Winning idea receive up to $1M; Schools receive $3K

www.playexchange.ca

 Reflects inventive ways to target specific populations, such as new immigrants, Aboriginal communities, families, remote communities

In Summary: Health Literacy, Culture, Language… Strategies to Improve Health Education/Communication

- Plain language

Communication Competence

Health Literacy

- Audiovisuals, pictograms, icons, colourcoding - Patient education - Teach back

- Coordination with Cultural Competence Access Understand Evaluate Communicate

Linguistic Competence

traditional healers - Culturally competent health promotion

- Test interpreters’ language proficiency

- Process for translators and translation “I speak” cards

(Adapted: Andrulis & Brach, 2007)

Contact Information: Dr. Sandra Vamos School of Public Health and Social Policy University of Victoria British Columbia, Canada [email protected] [email protected]

References 

Andrulis, D.P. & Brach, C. (2007). Integrating literacy, culture and language to improve healthcare quality for diverse populations. American Journal of Health Behavior: 31; Supp 1:S122-133.



Centers for Disease Control and Prevention. (2009). Simply put: a guide for creating easy-to- understand materials. Atlanta, GA: Author. http://www.cdc.gov/healthliteracy/pdf/



Frankish, J., Gray, D., Soon, C., & Milligan, D. (2011, March). Health literacy scan project report. Ottawa, ON: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada. [unpublished]



Frankish, J., Gray, & Milligan, D. (2012, March). Canadian health literacy examples from the field project. Final report. Ottawa, ON: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada. [unpublished]



Health Literacy for Action UC Berkeley. (2014). Health literacy and communication: Health communication tips. http://www.healthresearchforaction.org/health-literacy-communications



Mitic, W., & Rootman, I. (2012). Inter-sectoral approach to improving health literacy for Canadians. Vancouver, BC: Public Health Association of British Columbia. http://www.phabc.org/modules.php?name=Contentpub&pa=showpage&pid=182.



National Commission for Health Education Credentialing Inc. (2010). Responsibilities and competencies for health education specialists. Whitehall, PA: Author. http://www.nchec.org/credentialing/responsibilities/



Public Health Agency of Canada. (2012). Core competency statements. Ottawa, ON: Author. http://www.phac-aspc.gc.ca/php-psp/ccphcesp/stmts-enon-eng.php



Rootman, I., & Gordon-El-Bihbety, D. (2008). A vision for a health literate Canada report of the expert panel on health literacy. Ottawa, ON: CPHA. http://www.cpha.ca/uploads/portals/h-l/report_e.pdf.



Vamos, S. (2014). Health literacy and systems navigation university course. Vancouver, BC: Author. [Online undergraduate University of Victoria course – May, 2014]

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