How Health Literate Are You?

Brush up on your wellness knowledge during Health Literacy Week.

If you’ve ever handed in a script for medication or even bought over-the-counter meds and found yourself looking at the instructions on the accompanying leaflet, wondering what the heck they’re on about, you’re not alone.

I don’t know if you’ve ever given much thought to the average reading age of the population and how that relates to the often very complex information that usually accompanies medication, but the difference between the two is a worldwide issue. I’m going to concentrate mostly on the UK, but plenty of authors have written about how difficult it often is to read healthcare-related information — and that’s assuming no other conditions such as dyslexia or special educational needs.

There are recommendations that information provided for healthcare purposes should be written in language that a typical eighth grader can understand — but analysis shows that’s far from the case. Many patient leaflets and safety instructions for medications are closer to a reading age of eleventh grade — a whole three years on. And that’s just reading the instructions, not necessarily understanding it.

Health literacy has been a major workstream for Health Education England (now part of NHS England) for several years now. As part of this work, there’s an annual event, Health Information Week, with events covering different themes each year. It isn’t only NHS librarians who take part in this set of events — the focus is very much on sharing information and working in partnership.

In 2023, the events are taking place from Monday 3 July through to Sunday 9 July, and each day has a different theme, starting with Health Literacy on the Monday, before moving on in turn to Mental Health and Wellbeing, Women’s Health, Social Prescribing, Children’s Health, Cost of Living, and Shared Decision Making.

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As part of our library’s contribution, Monday will see me delivering a short session to colleagues from other parts of the healthcare landscape in Bolton, in the surroundings of the public library that’s currently under refurbishment. (It’s a gorgeous building, which also houses the town museum, dating from 1852, just a couple of years after the Library Act.)

The areas I’ll be looking at include health literacy in Bolton and how it compares to similar-sized towns in England, using a tool originally compiled by the University of Southampton. Although the data we have available is unfortunately from 2011 and hasn’t been updated since, it nevertheless gives a snapshot of just how inaccessible so much health information is for so many people. It was very apparent during the COVID-19 pandemic — it wasn’t only that this was a new virus about which barely anything was known, but the information coming out was contradictory and, in some cases, dangerous.

Research shows that, on average, over 43 percent of people in England struggle to understand health-related information (https://bmjopen.bmj.com/content/9/2/e024582 if you’d like to learn more about the research). 

There’s an average “national threshold” for literacy in England, and as with any average, there are also those below that line and those above the line. A quick interaction with the national map on the geodata site at http://healthliteracy.geodata.uk/, however, shows that there’s quite a cluster of areas with low literacy, numeracy, and health literacy.

The area in England with the best levels of health literacy is Hart in Hampshire, in the green and leafy southeast of the country, where around 27.48 percent of those in the sample found health information difficult to understand. In the City of London, the figure was 31.45 percent. Brighton and Hove, also in the south, were almost exactly on the “average” line in terms of health literacy, with 40.66 percent of the population experiencing issues with literacy, numeracy, and health literacy. The city where I grew up, Newcastle, which has a lot of the same social issues as my current place of residence in Bolton, just north of the city of Manchester, has 46.08 percent of the population experiencing difficulties, while in Bolton itself, the figure is 49.34 percent. For comparison, the City of Manchester itself had the most issues of any location in England — 53.6 percent of people struggle with health literacy.

As health librarians and information professionals, we can help by signposting users and partners to sources written in straightforward language, making use wherever possible of illustrations and short, simple language. Increasingly, Easy Read options are now available — some of which have been created nationally, others are more localised — there are examples at https://www.easyhealth.org.uk/pages/easy-read-health-leaflets-and-films.

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I’ve also recently seen effective use of ChatGPT and other large language models (LLM, or AI as a lot of people call them, though that isn’t strictly accurate — my favorite description of ChatGPT so far is “stochastic parrot” with stochastic meaning utter randomness). In the examples I saw, the prompts used required the LLM to produce or rewrite information on a condition that would be understandable for the average ten-year-old reader.

I’ve also been interested for a long time in information produced in languages other than English (including sign language and Braille). Small-scale early experiments suggest that LLMs might be a suitable tool for translating at least some information into what are often called community languages—for example, Urdu, Hindi, Chinese, and others. More research is, however, as ever, required. . . .

All of this also has a bearing on EDI, as it’s often called in the UK (Equality, Diversity, and Inclusion) or DEI (Diversity, Equity, and Inclusion) in the US. Everyone needs to be able to access the information they need to stay healthy and help others access health information.

Health literacy isn’t an easy topic to deliver or present, but Health Education England runs regular sessions for information staff, outlining various techniques to get the message across, as you can see at https://library.hee.nhs.uk/patient-information/health-literacy-and-patient-information, if it’s of interest. These include chunk and check, teachback, simple language — and lots of pictures. 

I’m looking forward to incorporating these into the session on 3 July — so flashcards, PowerPoints without too much text and in a clear and readable font, pictures, quizzes to chunk and check, and straightforward language at the ready!

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