Episode 30: New survey results shine a light on health literacy in Australia

Voiceover:

Welcome to the NPS MedicineWise podcast, helping health professionals stay up to date with the latest news and evidence about medicines and medical tests.

Steve Morris:

Hello, I'm Steve Morris, CEO of NPS MedicineWise, and welcome to the 30th episode of our podcast. In today's podcast, we're going to focus on health literacy, and more specifically, medicines literacy in Australia, both the challenges and opportunities that exist. So, look, despite significant efforts to improve health literacy over a number of years, a recently published report shines a light on Australian's health literacy. The survey findings published by the Consumers Health Forum in a report commissioned by NPS MedicineWise show a significant number of consumers need to be further supported to feel more in control of their health care. So, to help us explore these issues further, I have two guests with me today. Debra Letica is a health consumer advocate based in Western Australia. Hi, Deb.

Debra Letica:

Good morning. Thank you. Good to be here, Steve.

Steve Morris:

And Leanne Wells who's CEO of the Consumers Health Forum and is a repeat podcaster. Welcome, Leanne.

Leanne Wells:

Thanks, Steve. How are you?

Steve Morris:

Yeah, I'm good, thank you. Look, just to provide a bit of background first and then we'll kind of get into, I suppose, the meat of the conversation. So, look, this new research has given I think some excellent insights into what national health organisations can be doing differently and better and ways we can encourage health professionals to do better when it comes to providing easily understood information to consumers. So, just maybe just a few numbers from the report. So, this survey of more than 1,500 consumers found that about one in five consumers rarely or never felt comfortable asking their doctor, pharmacist, or nurse when they needed more information. Look, about the same number, one in five, rarely or never felt comfortable asking their health professional to explain anything they didn't understand, found the information the health professional gave them always or often confusing. Some challenges there. So, look, I'll go straight to you, Deb. Obviously, the focus is on health literacy. So, how would you describe health literacy to our audience?

Debra Letica:

Thanks, Steve. Health literacy to me as a consumer and a carer has two points. One is that I fully understand the medicines that are prescribed to me and my loved ones, why they're being prescribed, and how they are going to make me feel better, and is there anything I need to know about using them safely, and what are the costs. And also the second point is how to find or access health services that I need, sort of how to connect the dots. I think the correct term is how to navigate the system. That is challenging. That is very, very challenging.

Steve Morris:

Yeah. Yeah. Thanks. Thanks, Debra. And Leanne, anything to add to that?

Leanne Wells:

Well, I think it's really important that we think about health literacy as a systemic issue, and health literacy capability needs to be built both within health care organisations as well as among consumers because it's not a soft issue. It's actually health literacy. I mean, to pick up on Deb's points, it's health literacy and being able to sort of understand and appraise and act on critical information that gives consumers and their carers agency to get a better health outcome, whether that's around sticking with a medication regime or following through on a referral or following through on a care plan. It is a systemic issue, and I think it's important for clinicians to be aware of that and to take the time, which I know is often a challenge for many doctors, but to take the time to have those conversations. The ‘partners in care’ rhetoric is more than rhetoric. It actually has to be about a care partnership.

Steve Morris:

Yeah. Thanks, Leanne. Just building on that concept of the systemic nature of some of these issues, the report identifies a number of gaps which are preventing people from accessing what could be described as the best possible health care. Can you just explain some of those gaps that are identified in the report?

Leanne Wells:

Well, I think the gaps are... Where do you start to answer that question? Well, I think the first gap or concern is the variation in health literacy. The most recent report on that from... I mean, there's ABS and all sorts of statistics around this, but I think the Mitchell Institute's report on self-care for health, their national policy blueprint really underscored again that 60% of Australians appear to lack good, what we would call or consider good health literacy, and it just becomes more profound among people that are at high risk. So, those with multiple conditions, those that are taking lots of medications, those with English as a second language.

So, I guess, a gap in our system is a coordinated, cohesive approach to a health literacy strategy, and by strategy, I mean a strategy with health literacy programs and campaigns and those sorts of things. I mean, your organisation, Steve, is doing some great work in that space. I mean, the Choosing Wisely initiative and the whole idea of the wise consumer is a really important one, and Choosing Wisely and those sorts of campaigns are what we need more of. So, I think that that's the first gap that I really draw attention to.

Steve Morris:

Thanks, Leanne. And Deb, anything from your perspective you'd like to highlight?

Debra Letica:

Leanne certainly captures that very well. From a consumer perspective, I think as Leanne said, there is a variation in health literacy and that can happen to consumers when we're not feeling well. When we're feeling well, we have advocacy skills and we're in a place where we can make wise decisions, but when we're not feeling well, you're at the other end of that health literacy scale.

If I could just share a little bit of my own lived experience with you all. I have Graves disease, which I'm sure you all know about. Graves disease is an autoimmune thyroid disease that causes hyperthyroidism, and if it's left untreated, it can cause things such as weight loss, anxiety, depression, mental and physical fatigue. My thyroid was removed some time ago now, but since then I've taken thyroxine replacement hormones every day. As I approached menopause, my weight ballooned, and this caused me a lot of stress and anxiety, and because of the challenges with my weight, I was prescribed T3 as well as T4. But the most important thing here is that both the hormones need to be in balance. Unfortunately, mine were not, and I wasn't monitored correctly which then resulted in me becoming severely hyperthyroid again, which is not a happy place to be. So, I wasn't thinking straight and it took me a while to figure it out.

So, if I had've had someone that I could talk to and understood the side effects that I was experiencing, it would have made sense, and I wouldn't ended up in a crisis. So, that opened my eyes to being more focused on understanding my health and the effects of the medicines, and how to look after myself better. So, I began to ask questions of my family and loved ones about their own health and care, and during these conversations, it became very clear to me that it wasn't just me. I had a brother with complex health conditions with an intellectual disability and a Croatian mother-in-law. So, as Leanne was saying, those people who don't speak English as their first language often fall through the gaps. I've really learned the importance to understand all the medicines I'm taking, even over-the-counter ones and even nutritional products that may interact with those medicines that are being prescribed to me. So, it's a varying degree of health literacy depending on how well we are.

Steve Morris:

Thank you for those insights, Deb, and look, Leanne, just obviously the report in the way it analysed some of the data segmented consumers into different groups. So, can you explain what those groups are and why it's important to segment consumers in terms of considerations of improvements in health literacy?

Leanne Wells:

Yeah, look, it's important to segment consumers because consumers aren't one big homogenous group. They differentiate on lots of issues. They differentiate on obvious things like age, and disease, locality, but also on attitudes and propensity to act on health information, and they differentiate on having different degrees of activation as well.

So, the three key segments that the research unearthed were a group of consumers who fundamentally believe in prevention and preventative health, and they're more likely to be the most active in their own health care and have the highest levels of health literacy. A second segment were those for whom primary care is a sort of a trusted necessity. It's pretty transactional. They get what they need from their doctor and leave, and they're not particularly active and engaged in their own health and wellbeing. And then a third segment, again, they're what people for whom health care was a quick fix. They're happy to take what their doctor recommends. Again, not particularly engaged in wanting to have discussions about medications, wanting to be very active in their own health care. They just want the pill or the referral. It's sort of, again, that sort of transactional thing. Why segmentation is important is it allows us to really target health messaging and health programs and health services.

Steve Morris:

Yeah, that's really important in terms of making some of those improvements we need to make. And, Deb, just going back to you, and obviously, you talked about your personal experience, but in terms of healthcare professionals and perhaps from your own experience, what do you think healthcare professionals could do better in terms of improving health literacy and enabling consumers to make good choices?

Debra Letica:

What's the secret ingredient? I always think of secret ingredients. For me, I think consumers really need to feel safe. We've got to feel safe to be able to open up and communicate with health care professionals, and that doesn't always happen very well. If health professionals can just take that time to listen, and by listening, I mean to being present with the person in front of you, to connect on a human level. Listen with empathy, kindness, compassion, and understanding, and then by doing that, consumers will feel safe and it will empower us to be confident in asking questions of health professionals. But through my lived experience of my own experience and looking after in my carer role, I've become really focused on understanding the importance of forming relationships with my doctors and my pharmacist.

And as Leanne mentioned earlier, there's some tools out there that I've started to use, and Choosing Wisely five questions is one of them. They are so powerful, and I so wish I had have learned that many years ago. It would have certainly saved me a great deal of heartache. And the Choosing Wisely five questions are simple. They're available in different languages which would have helped with having a chat with Mum when she was trying to understand her medicines in Croatian. It's just so important that that relationship is formed in those safe places. I have recently formed a relationship with my community pharmacy now for a few years, and it's really nice to walk into that community pharmacy, and they greet me by name, and it makes me feel welcome and safe to ask some questions.

Like recently I decided to take a nutritional supplement. So, I went into my community pharmacy and asked them which one they recommended and the pharmacist was showing me some products, and then she suddenly said to me, "Hang on, Deb. Don't you take thyroxine?" And I said, "Yes, I do." And then she said, "Well, we better find one without iodine in it so it doesn't interact with your medicines that are being prescribed." So, I was really amazed that she even remembered that, but it was really nice that she actually cared about me. And in my eyes, those relationships like that, that are formed on trust is really shared decision-making in action. And as we know, shared decision-making is a key enabler for quality health care and reducing low-value care. So, I think it's about consumers knowing to use the tools that are available and health professionals encouraging us to form a relationship with them on an ongoing basis.

Steve Morris:

Yeah, no, thanks for that, Deb. It's really vital. Leanne, anything you want to add to that?

Leanne Wells:

On the issue of complementary medicines, I mean, that's an interesting one, isn't it? That sort of advice and the value of a community pharmacist who knows you is so important. I think the other point I would make too, the big confounder in terms of health literacy and people not being enticed into using products that are of no use to them, or have contraindications with medications they're on is a real risk. And I'm talking here about the need to really counter health misinformation on the internet, and I know the AMA earlier in the year called on the government to do more about improving health literacy, but particularly with respect to the proliferation of things and information that are now on the internet.

I think we've really got to, in addition to equipping and reinforcing the safety and the confidence that that patients need to have the conversation directly with doctors and pharmacists and nurses and the like, we also need to be directing people to quality websites, authoritative websites, because people access so much information now on social media and on websites. So, the more we can sort of do practical things like using search engine optimisation so we're driving people to things like HealthDirect. We're driving people to NPS MedicineWise consumer information. We're really drawing attention to the tools that Deb talks about, the five questions to ask your doctor, five questions to ask your pharmacist, the question builder tool that can really help consumers customise questions to ask their doctor. I think that whole internet and the proliferation of all that information is - we've got to really help people navigate that as well.

Steve Morris:

Yeah. Look, I think that's a key component, isn't it? Lots of the things, let's call it, on the internet you could argue are counter to improving health literacy.

Leanne Wells:

Mm, absolutely.

Steve Morris:

And I think organisations like NPS MedicineWise and others, it's incumbent for us to provide resources that are straightforward, easy to understand to enable some of this improvement in health literacy, but also how do you get through the noise of all the other information that's on the internet, I think that's really, really critical. And I think, look, for organisations like NPS MedicineWise or CHF where we try and to develop content for consumers, what do you think the insights from this particular report mean in terms of the work we should be focusing on, Leanne?

Leanne Wells:

Well, look, I think again, to sort of take heed from some of the points that Debra's made, we don't need complicated messaging. I think just simple things like the simple five questions, they are so powerful, for example. And I think what we need to do is get creative about how we get those messages out there, multimedia channels, and I suppose we just, and I'm not talking about NPS MedicineWise and CHF exclusively here, I'm just talking about across the board, there's some really good, creative public health campaigns that can really activate and motivate people so well.

I'd like to see any health literacy programs and strategies really take us away from being too conservative in the way we communicate public health messages and QUM-related messages and other health messages to people, and I think we've got a window there to do that. We've got a national draft, at least national preventative health strategy that's out for consultation or was recently out for consultation a month or so ago, and it had a health literacy strategy as one of eight immediate priorities. I'd really like to see us work with all the players and government to get a health literacy strategy that's action-oriented and has some really nice, simple, cut-through messages in key areas where we do need to activate people with the right information at the right time.

Steve Morris:

Yeah, thank you for that, Leanne. And the report made several recommendations. What do you think is the most challenging of all those recommendations coming out from the review?

Leanne Wells:

Well, it's all challenging.

Steve Morris:

Yeah.

Leanne Wells:

I mean, health literacy is challenging, and I think that the big challenge with health literacy, I think it can tend to get sort of brushed aside as a bit of a health promotion, soft issue when we're talking hospitals and hospital access, and some of those really hard, pointy-edged issues and challenges for the health system, it's a bit like preventative health, and the investment in it gets pushed back, back, back all the time. So, I think our first challenge is just getting policy and the system to realise health literacy is not a soft issue. It's actually a fundamental pathway to good health care, and we need to invest in some good health literacy programs and involve consumers. Segmentation research is one thing, but then involving consumers in shaping those messages, in designing things like the five questions and what might follow those, for example, is really important because that is what will carry resonance with patients.

Steve Morris:

Yeah. And just hot off the press, it was announced last night that the National Medicines Policy will start its review process. What opportunity do you think that provides to highlighting the health issues we've talked about today?

Leanne Wells:

Well, I'd be, yeah, be interesting to do a word search on the current National Medicines Policy for health literacy. I don't think it's mentioned in there at the moment. Not that I've studied it word for word, but I think it is an opportunity, that policy, the preventative health strategy, it is an opportunity to get that authorising policy environment through revisions to policies like the National Medicines Policy to have health literacy and QUM and medications literacy written in there and reinforced as a priority. QUM's in there. It's the fourth pillar, but I think we can strengthen that. I think that's what we should be striving for.

Steve Morris:

Okay, thanks, Leanne. Any thoughts from you, Deb?

Debra Letica:

Yes, Leanne's just nailed it, and I just can't wait for it to be rolled out because I think it's through COVID, consumers are more focused now on their health. We're ready to go on this journey and learn more about health prevention. The only way I came to it is because through a crisis and that was just so unnecessary, and I think we should beginning very early on in our lives to be interested in our health and wellbeing.

Steve Morris:

Thanks then. And just maybe for both of you to give one last key message to our audience and our audience is mainly healthcare professionals. So, is there one last thing you'd like to say to our audience? Start with you, Deb.

Debra Letica:

Just remember that it's so important to look at the person in front of you and create a safe place for them to be able to engage with you. We've got to feel safe to engage.

Steve Morris:

And Leanne?

Leanne Wells:

Just be open to consumers asking questions. I mean, that's a good thing. The fact that they're engaged enough to want to ask questions and to have done some googling before a consult is not a bad thing. It means they're wanting to know.

Steve Morris:

Thank you, Leanne, thank you, Deb, for your contribution to this podcast. Hope you've enjoyed the chat.

Debra Letica:

Thank you.

Leanne Wells:

Thanks again for the opportunity, Steve.

Steve Morris:

Thank you. And I'll probably just sum up by saying, look, it's pretty clear that health literacy is core to us delivering more equitable health outcomes, and it's incumbent on everybody who interacts with consumers to do what they can to contribute to improving health literacy, and we look forward to, as NPS MedicineWise, to continue to working with CHF and other partners to produce practical resources for healthcare professionals in relation to medicine literacy so we can be part of improving healthcare in this way. So, thanks for listening.

Voiceover:

For more information about the safe and wise use of medicines, visit the NPS MedicineWise website at nps.org.au.