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Chapter 2
REVIEW OF RELATED LITERATURE AND STUDIES
This chapter presents the relevant literature and studies that the researcher
considered in strengthening the claim and importance of the present study.
Defining Health Literacy
The U.S. Department of Health and Human Services (HHS) 2010, defines health
literacy as "the degree to which individuals have the capacity to obtain, process, and
understand basic health information and services needed to make appropriate health
decisions."
Literacy gives us the skills to understand and communicate health information and
concerns. When we apply these skills to a health context, such as reading a nutrition
label or getting a flu shot, patient preparation for laboratory tests, it is called health
literacy.
Gloor (2014) Filipinos take pride in the country’s high literacy rate. This high literacy
rate, however, does not automatically translate to a high health literacy rate among
them. The low level of health literacy is a major factor in the issue of significantly
decreasing the number of unhealthy and sick Filipinos.
Dr. Anthony Leachon, president of the Philippine College of Physicians, said in a forum,
that when patients come to health care professionals to seek medical advice, they are
already very sick. “This should not be the case. This is failure of health literacy,” he
explained.
The US Centers for Disease Control and Prevention (CDC) stated, Health literacy
includes the skills and knowledge we have about a wide range of health topics and
circumstances. We might need to understand bodily functions, terms for specific health
conditions and the ways scientific results and risks are reported. Health literacy also
involves cultural influences on both the professional and the public.
Until recently, health literacy research has focused largely on problems and solutions in
the healthcare system, such as
• Communication between healthcare providers and patients
• Medication management
• Informed consent
Health Literacy is A Public Health Priority. Healthy People has identified health literacy
as a priority area in disease prevention and health promotion. “In the Philippines, we
have failed in health literacy. Why? We have a lot of medical and health knowledge, but
many Filipinos fail to comply with what is needed and must be done about their health,”
Leachon said.
Health literacy involves more than communication between physicians and their
patients, or developing written materials in plain language, although these are important
components.
Health literacy for individuals and communities is essential for understanding a health
risk, voting on an environmental issue, recognizing biases in health information reported
by the media, or responding to alerts and warnings, such as those for severe weather.
Take for instance, Customers buying medications always ask questions which must be
properly and appropriately answered by pharmacists. “Otherwise, the unanswered
questions may lead to a bigger concern, such as self-medication or total disregard of a
potential health risk,” Chiong said.
Williams (2014) Another example is when laboratories fail to adequately communicate
important information to the patients, Inadequate directions or signage to a phlebotomy
collection site may prevent access to healthcare, while small print and unnecessarily
complex forms can lead to misunderstandings regarding test preparation or
interpretation. One group of researchers reported that among patients who have access
to their test results, 68% could not interpret a blood glucose value. While labs may feel
that this is the provider's role, lab data may be so poorly organized or formatted that
patients may easily overlook important findings. (AACC Clinical Laboratory News, para.
5).
Various attempts of the Philippine government to address the low health literacy of the
Filipinos failed, respective senate bills on health literacy was filed, these are the Senate
Bill No. 2681 of NATIONAL HEALTH LITERACY ACT OF 2008 in the 14th Senate
Congress filed on October 16, 2008, the bill again was filed on 15th Senate Congress
under the Senate Bill No. 1673 and the lastest was Senate 1315, “AN ACT TO
ENSURE THAT ALL FILIPINOS HAVE BASIC HEALTH LITERACY SKILLS TO
FUNCTION EFFECTIVELY AS PATIENTS AND HEALTH CARE CONSUMERS” it is
Bill that will benefit all the filipino citizens to make a sound and timely decision
concerning the protection of their health, encouragingthe patients and the health
providers to avail of preventive medicine instead of curative because preventive
medicine is less costly and gives the family less burden than curative, all was
introduced and filed by late, Former Senator Miriam Defensor Santiago.
The Role Of Philippine Media In Disseminating Public Information On Health
Ramon Tuazon, president of Asian Institute of Journalism and Communication and
secretary general of Asian Media Information and Communication Center (AMIC) on the
information literacy conference conducted by the Department of Health at the University
of the Philippines Bahay ng Alumni said, that much of Filipinos are over-entertained and
under-informed without understanding the effect of some television programs in general.
“Health programs shown in Philippine television showcase more of entertaining,
emotionally-driven, rather than truly educating and pushing the meaning of public
service,” Tuazon said. “Due to consumerism and commercially-driven stories as
purpose of media especially in public service that will make the audience more of
entertained rather than informed and educated, the public preference became also
more of entertainment over information and education,” he added.
Tuazon also explained that the level of health literacy in the Philippines is low because
media messages that are supposed to create public understanding and knowledge on
health, are much of for awareness and not for real application.
A suggested community-based health delivery interventions creating innovative heath
promotion initiatives on how to capacitate Health Education and Promotion Officers also
known as (HEPO) were presented in the conference.
The suggested Initiatives are:
1.) To popularize the technical terms without diluting intended messages. In
contrast, the CDC suggests not to use technical or medical terminology.
Words such as pandemic, immunize, transmit, influenza, and prevalence are
examples of words that are often misinterpreted.
2.) Create media platform for specific target audiences or as the CDC emphasized that
it should be participatory and user-centered.
3.) Educate the mother, family and community through mobile health applications
promoting health literacy. The CDC listed the strategies including, use culturally
and linguistically appropriate messages, consider the current literacy level of the
intended audience, and design messages based on that level, improve the
usability of health information making the messages more understandable.
A similar suggested action was emphasized by Prof. Williams, MD in about the
important roles of a health provider such as the Medical Laboratory Technologist in
health communication and literacy.
Health literacy for Health Professionals
Public health professionals play a critical role in ensuring that the public receives
reliable, accurate information that will help individuals make informed decisions about
their health. Working with media, community organizations, and other stakeholders to
disseminate clear, actionable information can decrease the likelihood of conflicting
messages and lead to a coordinated effort to reach intended audiences. (CDC Health
Literacy Training. (n.d.)).
Health Literacy of Medical Technologist
As consumers take on more responsibility for their own health, health literacy is fast
becoming a patient safety issue that is relevant to clinical laboratory services. In an
interview, Professor Mark V. Williams, MD, FACP, FHM, a national expert on health
literacy, and the chief Division of Hospital Medicine at Northwestern University Feinberg
School of Medicine in Evanston, talks about actions labs can take to overcome
communication barriers.
Prof. Williams said, Healthcare providers should use "living room" language that
patients can understand, but they should also use the proper medical terms. Some of
these medical terms may have general connotations that are different than what we
intend clinically. For example, when explaining test results, providers should be cautious
about using the terms positive and negative. A negative test result is often good, but the
patient may perceive this as a bad outcome. Other common words that patients
misunderstand are terminal, hyper, and malignant, as well words that refer to concepts
such as normal range.
He added, Labs should develop well-written patient material, such as forms and
educational information, that is appropriate for everyone, including people with limited
health literacy skills. Important information should be bolded or highlighted. These
materials should be assessed for effectiveness, preferably by real patients. For labs that
have direct contact with patients, it is important to greet them with a warm, friendly
attitude; use plain, non-medical jargon; speak clearly and at a moderate pace; limit
instructions to three-to-five key points; repeat the key points; and use illustrations if
necessary. Finally, it is always important to provide non-threatening opportunities for
patients to have their questions answered.
Applying Health Literacy to a Public Health Framework
In 1988, the Institute of Medicine (IOM) recommended that federal, state and local
health agencies increase their administrative capabilities in the following three core
functional areas:
• Assessment
• Policy development
• Assurance
Core Function of Public Health: Assessment
The two essential services in public health assessment are
• Monitoring health status to identify and solve community health problems
• Diagnosing and investigating health problems and health hazards in the community
In a complete needs assessment for a population, health literacy must be considered in
the systematic analysis of health issues.
As you learned earlier, only 12% of adults have the required skills needed to effectively
manage their health and prevent disease. This tells us that there is a good chance there
will be individuals in your communities with limited health literacy skills. We should
monitor the prevalence and distribution of skills in communities to determine the impact
on health at the same time we target groups with the most limited skills to receive
appropriate information and services.
What Can You Do?
• Form advisory groups to advance health literacy by advocating for resources,
researching health literacy related issues, planning effective programs, and
gaining access to potential community gatekeepers and other resources.
• Design and conduct a needs assessment to identify areas in which limited health
literacy might affect use of local programs and services.
• Start with population demographics; know your target audience. Some
communities are more affected by limited health literacy than others.
Core Function of Public Health: Policy Development
The three essential services of policy development include the following:
• Inform, educate, and empower people about health issues.
• Mobilize community partnerships to identify and solve health problems.
• Develop policies and plans that support individual and community health efforts.
The Institute of Medicine Roundtable on Health Literacy external site has held several
workshops and published reports that show how public policy and partnerships can
address limited health literacy and its effects. The reports identify current health literacy
issues and suggest many important policy directions and partnerships for reducing the
economic, social, and health burdens of limited health literacy.
Core Function of Public Health: Assurance
• Take advantage of any local and state invitations to give talks about health
literacy.
• Work with local and state partners to ensure health literacy is a common priority.
The four essential services of assurance include the following:
• Enforce laws and regulations that protect health and ensure safety.
• Link people to needed personal health services and assure the provision of
healthcare when otherwise unavailable.
• Assure a competent public health and personal health- care workforce.
• Evaluate effectiveness, accessibility, and quality of personal and population-
based health services.
These essential elements provide direction for delivering quality care and services to
our intended audiences. The Institute of Medicine (IOM) states, "Good quality means
providing patients with appropriate services in a technically competent manner, with
good communication, shared decision-making, and cultural sensitivity." Health literacy
improvement is a crucial component of quality care.
BIBLIOGRAPHY
CDC Health Literacy - Home - Health Literacy Training. (n.d.). Retrieved December 2,
2018, from https://www.cdc.gov/healthliteracy/training/index.html
Health Literacy. (n.d.). Retrieved December 2, 2018, from
https://health.gov/communication/literacy/powerpoint/slides1_20.htm
Health Literacy. (2010). Retrieved December 3, 2018, from
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-
health/interventions-resources/health-literacy
Gajete, S. (2017, November 07). Media not addressing health literacy. Retrieved
December 02, 2018, from https://www.manilatimes.net/media-not-addressing-
health-literacy/361156/
Gloor, R. (2014, June 27). Health literacy. Retrieved December 3, 2018, from
http://www.pchrd.dost.gov.ph/index.php/news/library-healthnews/3590-health-
literacy
MATEO, I. C. (2014, June 18). Low health literacy level alarming, making Filipinos 'more
sick' – doctor. Retrieved December 3, 2018, from
https://www.gmanetwork.com/news/lifestyle/healthandwellness/366216/low-
health-literacy-level-alarming-making-filipinos-more-sick-doctor/story/
Santiago, M. D. (2008, November 10). 14TH CONGRESS SENATE BILL NO. 2681
NATIONAL HEALTH LITERACY ACT. “AN ACT TO ENSURE THAT ALL FILIPINOS
HAVE BASIC HEALTH LITERACY SKILLS TO FUNCTION EFFECTIVELY AS
PATIENTS AND HEALTH CARE CONSUMERS”. Retrieved December 3, 2018, from
https://senate.gov.ph/lis/bill_res.aspx? congress=14&q=SBN-2681
Santiago, M. D. (2010, September 08). 15TH CONGRESS SENATE BILL NO. 1673
NATIONAL HEALTH LITERACY ACT. “AN ACT TO ENSURE THAT ALL FILIPINOS
HAVE BASIC HEALTH LITERACY SKILLS TO FUNCTION EFFECTIVELY AS
PATIENTS AND HEALTH CARE CONSUMERS”. Retrieved December 3, 2018, from
hhttps://www.senate.gov.ph/lis/bill_res.aspx? congress=15&q=SBN-1673
Santiago, M. D. (2013, September 04). 16TH CONGRESS SENATE BILL NO. 1315
NATIONAL HEALTH LITERACY ACT. “AN ACT TO ENSURE THAT ALL FILIPINOS
HAVE BASIC HEALTH LITERACY SKILLS TO FUNCTION EFFECTIVELY AS
PATIENTS AND HEALTH CARE CONSUMERS”. Retrieved December 3, 2018, from
hhttps://www.senate.gov.ph/lis/bill_res.aspx? congress=15&q=SBN-1673
Williams, M. (2012) The Impact of Health Literacy on Patient Safety. How Labs Can
Confront the Challenges of Low Health Literacy. Retrieved December 3, 2018,
https://www.aacc.org/Publications/CLN/Articles/2012/january/HealthLiteracy.aspx