SNAPW: Improve these behaviors to prevent chronic disease Smoking, Nutrition, Alcohol,
Physical activity, Weight To
find out which providers can improve health literacy for prevention, Australian
researchers completed a systematic review of quantitative studies (What works?)
and narrative synthesis of qualitative work (Why? How?). The review covers
research published 1985 to 2009, much of which was done by US researchers. The
authors focused on “members of the primary care team” —providers working in
general and family practice, community health, home nursing, private or public
allied health, health education, or information— and evaluated their effectiveness in promoting
positive change in health literacy and SNAPW behaviors. The researchers ran into some
issues that I’ve come up against in an ongoing scoping review to discover what is known about the impact of mothers’
health literacy on maternal-child health. Health literacy and related concepts
are poorly indexed, so it is necessary to search on lots of terms. The Aussies
wrestled 4691 papers down to 94. We started with 2600+ and are still wrestling.
There are many varied outcome measures. There are 50+ instruments to
measure functional heath literacy (reading & math) and none to measure interactive
or critical health literacy.
Nonetheless, this research report is on my must-read list. Take Home Messages 1. Health literacy can be improved; 71% of reviewed studies demonstrated improvement in
health literacy. (A round of
applause for the researchers who published what did not work.) Some interventions improved
health literacy (measured as knowledge, skill, attitude, self-efficacy, states
of change, motivation, or patient activation) without affecting behaviors. This
result supports other findings that knowledge and skill do not necessary
translate to health promoting action; people make informed choices to not
act on what they know.
On the other hand, some interventions resulted in improved behavior
(smoking) without affecting health literacy; that supports previous findings
that specific knowledge may not be a prerequisite for behavior change. One RCT*
found that brief counseling by a physician led to increased patient action, but
only those who were referred to group programs demonstrated improvement in diet
and weight. I suspect that
improvement in one health literacy indicator is insufficient to support
behavior change, which likely requires some combination of knowledge and
skills and motivations and self-efficacy and social
support. 2. Non-physician providers are effective health literacy promoters. Nine of 10
interventions provided by nurses, dietitians, health educators (92%) or
multidisciplinary teams (91%) improved health literacy. Compare that to three
of nine (33%) interventions provided by physicians. 3. Intensity of the intervention seems to be the
difference. One study found the
average length of visit with a primary care physician was 8 minutes shorter
than the time it takes to deliver smoking cessation counseling. Indeed, time
was the barrier to improving health literacy most frequently mentioned
mentioned by providers, followed by attitudes and beliefs. Most
physician-delivered interventions were brief, one-time encounters. In
comparison, interventions delivered by non-medical service providers ranged
from 6 hours to 2 years. Limited time in clinical settings may preclude the
trusting relationship required to support behavior change. Conclusion:
Moderate to high intensity
interventions are needed to address SNAPW behaviors. Production demands in primary care settings (see 30 patients
a day) limit physicians to brief interventions that can increase knowledge and
motivate patient action but rarely result in improved behaviors. Call to Action Clinicians: to improve health literacy for
prevention of chronic disease, collaborate with-, refer to- and promote
participation in intensive programs led by other health professionals and
paraprofessionals. Health
educators, home visitors, community health workers, dietitians, public health
nurses, social workers, case managers, parent educators, program directors:
collaborate with clinicians to integrate health literacy promotion into your
usual activities, organize referral relationships, bridge home and healthcare. *RCT: Randomized Controlled Trial Reference Dennis S, Williams, A, Taggart J,
et al. (2012). Which providers can bridge the health literacy gap in lifestyle
risk factor modification education: a systematic review and narrative
synthesis. BMC Family Practice. 13:44. 91 citations. Open Access. Free at http://www.biomedcentral.com/1471-2296/13/44 |
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CategoriesHealth LiteracyMaternal Child Health Test |
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