doi: 10.56294/saludcyt2024910

 

SHORT COMMUNICATION

 

Health Literacy: Professional Competence for 21 st Century Healthcare

 

Alfabetización sanitaria: Competencia profesional para la atención sanitaria del siglo XXI

 

Maria Leonor Carvalho1  *, Maria Inês Carvalho2  *, Marta Carvalho3  *, Susana Valido4,5  *, João Tomás4  *, Sandy Severino4  *, Luís Sousa4,6  *

 

1Hospital Ortopédico de Sant`Ana, Parede, Portugal.

2Agrupamento de Escolas Aquilino Ribeiro, Porto Salvo, Portugal.

3Centro de Medicina Física e de Reabilitação do Alcoitão, Alcabideche, Portugal.

 4Atlântica School of Health (ESSATLA), Atlantic University, Nursing Department, Oeiras, Portugal.

5Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR). Nursing

School of Lisbon. Lisbon. Portugal.

6Comprehensive Health Research Centre, Évora, Portugal.

 

Cite as: Carvalho ML, Carvalho MI, Carvalho M, Valido S, Tomás J, Severino S, Sousa L. Health Literacy: Professional Competence for 21 st Century Healthcare. Salud, Ciencia y Tecnología. 2024; 4:910. https://doi.org/10.56294/saludcyt2024910

 

Submitted: 14-12-2023                       Revised: 03-03-2024                                       Accepted: 11-05-2024                       Published: 12-05-2024

 

Editor: Dr. William Castillo-González  

 

ABSTRACT

 

Health literacy consists of a set of cognitive and social skills and the ability of individuals to understand and use health information. Low levels of health literacy leads to higher rates of hospitalization, mortality, and premature death, as well as poor adherence to treatment regimens, reduced prevention and poorer health status, with a negative impact on individual and collective health. In Portugal, the most vulnerable groups (the elderly, the unemployed, low levels of education) have “problematic” or “inadequate” levels of literacy. This article therefore reflects on the importance of creating training and capacity-building programs for health teams and professionals in health literacy, concluding that the responsibility for promoting health literacy is a collective one, with health professionals playing a central role in this regard, and that it is up to health organisations to prepare work teams in health literacy and monitor their progress.

 

Keywords: Literacy; Education; Health; Empowerment.

 

RESUMEN

 

La Alfabetización en Salud consiste en un conjunto de habilidades cognitivas y sociales y la capacidad de las personas para comprender y utilizar información sobre salud. Los niveles bajos de alfabetización en Salud conllevan mayores tasas de hospitalización, mortalidad y muerte prematura, así como baja adherencia al régimen terapéutico, reducción de la prevención y peor estado de salud, impactando negativamente en la salud individual y colectiva. En Portugal, los grupos más vulnerables (ancianos, desempleados, bajo nivel educativo) tienen niveles de alfabetización “problemáticos” o “inadecuados”. Este artículo reflexiona así sobre la importancia de crear programas de formación y capacitación de equipos y profesionales de la salud en alfabetización en Salud, concluyendo que la responsabilidad de promover la alfabetización en Salud es colectiva, tiendo los profesionales de la salud un papel central en este sentido, siendo las organizaciones sanitarias las responsables de su preparación. Equipos de trabajo de alfabetización en Salud y seguimiento de sus avances.

 

Palabras clave: Alfabetización; Educación; Salud; Empoderamiento.

 

 

 

INTRODUCTION

Social transformations have an impact and cause changes at the level of health systems. Over the last few years, we have evolved from a paternalistic health model to a collaborative and participatory health model, in which citizens have access to information and make their own decisions, presenting themselves as partners of both the system and of the health professionals in the decision-making processes.(1,2,3,4) Considering that the most vulnerable groups of the population have “problematic” or “inadequate” levels of literacy,(5,6,7) this process is not always easy.

Therefore, there is an urgent need to create mechanisms that allow citizens to effectively become partners in healthcare. Although there has been a positive evolution in health literacy (HL) levels in Portugal in recent years, it remains a need, not only for the general population, but also for health professionals, being identified in the National Health Plan as one of the priorities for intervention.(6,8)

The challenges of promoting it are not exhausted. Among other initiatives aimed at promoting HL, this article aims to reflect on the importance of creating and effectively implementing capacity building and training programs for teams and health professionals in HL.

 

RATIONALE

HL reflects the level of capacity that each person has to obtain, communicate, process and understand information, as well as use health services in order to make appropriate health decisions, in order to maintain and/or improve their health throughout the life cycle. It also includes the ability to participate in health advocacy and governance.(9,10,11,12) It is a multidimensional concept defined by the World Health Organization (WHO) as the set of “(..) the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.”(13,10)

This concept plays a preponderant role in maintaining and improving health and should be explored when disparities in health conditions are found. According to Nutbeam(14), literacy is made up of two elements: tasks and skills. Levels of HL range from a functional level (the ability to understand health information) to high levels (self-control, critical thinking, reflection).(15,16,17,18)

The level of HL affects the ability to make appropriate decisions regarding health care, disease prevention, and promotion of healthy lifestyles. The research carried out shows that high levels of health literacy are associated with better use of health services, better health status and quality of life, reduced health spending and increased health knowledge. Low HL levels are associated with higher rates of hospitalization and re-hospitalization, mortality and premature death, as well as low adherence to the therapeutic regimen, decreased use of preventive measures and worse health status.(5,19,20,21,22)

They have significant implications for individual and collective health, as well as for the management of health resources and spending. In Portugal, there has been a positive evolution in the population's HL levels.

The results of the European Health Literacy Survey reveal that Portugal is among the countries in Europe with the best HL level, presenting a higher proportion of participants with “sufficient” literacy levels (65 %).(19) The results are lower in populations considered vulnerable (elderly, unemployed, low education), where 29,5 % record “problematic” or “inadequate” literacy levels.(5,6,7)

Despite this evolution, HL remains one of the needs felt by the population and health professionals, and there is still a long way to go. Therefore, the challenges in promoting HL are not exhausted, on the other hand, they require the development of effective actions, which imply an integrated approach that includes citizens, health professionals and political decision-makers.

The National Plan for Literacy in Health and Behavioral Sciences 2023-2030, carried out by the Direção Geral de Saúde (DGS) (DGS) [the portuguese equivalent to the Surgeon General's Office], in alignment with the National Health Plan, among others, has as a priority area the development of methods and means of promoting health HL in order to train specific groups, which include healthcare professionals.(6)

Also, Scotland's HL Action Plan determines, for 2025, that all healthcare professionals demonstrate their professionalism through approaches, behaviors, and attitudes, based on a culture of shared professional-citizen decision-making. It references the principles that healthcare professionals should incorporate when communicating with their users (empathy, teach-back, among others).(23)

Portugal also recognizes the need to create guiding tools that enable health professionals to effectively promote HL in the populations in which they intervene. Thus, the DGS creates the HL Good Practices Manual, a guiding guide for health professionals within the scope of HL, which provides strategies to facilitate the process of citizen-professional interaction and communication.(24) Also, the strategic objective 1.3 of the National Plan for Patient Safety 2021-2026 focuses on increasing safety in communicating.(25)

The responsibility for promoting HL is undoubtedly collective, with health professionals playing a central role in this regard. One of the attributes of health organizations promoting HL is to prepare HL work teams and monitor their progress.(12,26,27,28,29)

Education and training in the area of HL allows the creation of a culture in which all professionals have an active role in promoting successful communication. It is through appropriate language and communication, in each cultural context, that the individual is able to access, use, understand, evaluate and interpret the system that surrounds them, in order to make decisions about their health.

A healthcare team properly trained in HL is aware of the real difficulties faced by people with low literacy levels, adapting their intervention in order to obtain better health, individual and social results. Admirable initiatives have been created to build HL across Europe.

In Portugal, the “I take care of my health” project and the “2’to change my life” project stand out, winners of the 2023 National Health Literacy Award.(30) There are numerous other initiatives such as the project “Network of Health Promoting Schools”, “Henry: HL promotion program for the prevention of childhood obesity”, “Patient safety in the first person”, “DIGISAÚDE”, “Health Literacy in the Cardiovascular area”, among others. All of these initiatives allow the construction of references guiding the safest professional-citizen approach, while at the same time integrating permanent interaction between stakeholders, professionals, organization and people.

There are many challenges associated with developing effective responses to real HL needs. It is important to adapt strategic planning that allows for the promotion of literacy not only among populations, but also among health teams and professionals. Therefore, it is suggested the creation of a program to promote HL for health teams and professionals, which included training and skills training in HL, considering the organizational context in which they operate, the degree of HL of the community to whom they provide care, and the teams in which they are integrated, as well as the individual characteristics of each one.

 

CONCLUSION

HL presents itself as a professional competence for healthcare in the 21st century, which, when properly developed, brings major gains to healthcare. Health professionals have a crucial role as promoters and activators of HL, in their different contexts of activity. It is therefore imperative to develop and implement continuous capacity building and training programs for health teams and professionals, taking into account their intervention context.

 

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FINANCING

No financing.

 

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

 

AUTHORSHIP CONTRIBUTION

Conceptualization: Leonor Carvalho, Inês Carvalho, Marta Carvalho and Luís Sousa.

Drafting - original draft: Leonor Carvalho, Inês Carvalho, Marta Carvalho and Luís Sousa.

Writing - proofreading and editing: Leonor Carvalho, Inês Carvalho, Marta Carvalho, Susana Valido, João Tomás, Sandy Severino and Luís Sousa.