Transcript Health Literacy in Greece: Exploring Sources of Health

Health Literacy in Athens, Greece:
Exploring Sources of Health
Information in Adults
Barbara Kondilis MSW, MPH , Patrick D. Akrivos, M.A.,
Sandy Salloum, BBA, & Matthew E. Falagas,MD, MSc, DSc
EHMA Annual Conference
June 25-27, 2008 - Athens, Greece
Literacy
The person’s ability to read, write
and speak a language, in addition to
solve problems at a level that allows
functioning at work and in society, as
well as achieving goals and
developing potential and knowledge
Bouchard, 2007
Health Literacy
The degree of the person’s ability to
obtain, process and understand basic
health information and utilize services
required to make appropriate health
decisions
Bouchard,2007;Kirksey et al., 2004; Mayer et
al., 2004;Gazamararian et al., 2005;
What is health literacy?
(simply)
Health
literacy is the ability to
read (access),
understand,and act on
health information.
Definition: The Center for Health Care Strategies Inc., 2000
Health, composed of a
sound mind and sound
body was the foundation
of the ancient Greek
ideal of life
Education and high levels of literacy
is essential in any society’s economy
and development and acts as a
determinant of health.
People with low literacy levels are more
likely to have poorer health.
Parker et al., 2003; Nutbeam et al.,
2000; Lindau, et al., 2002;
Greece has never conducted in-depth
studies on functional adult literacy
similar to the National Assessment of
Adult Literacy (NAAL) or the National
Adult Literacy Survey (NALS)
conducted in the United States
through the U.S. Department of
Education’s National Center for
Education Statistics.
More info on U.S. Adult literacy: U.S. Department of
Education, National Center for Education Statistics
http://nces.ed.gov/naal/
Our study’s focus:
 The
exploration of the sources of
health information with particular
focus on the use of pamphlets
 The reasons for the patients’ medical
visit to the doctor
 Frequency of doctor visits within the
last six months
 Patient and health-care provider
communication
Methodology
A self-report type questionnaire was
developed:
(consisting of 46 questions divided into five sections)
1.
2.
3.
4.
5.
Personal demographics,
Reasons for visiting the hospital or the
physician’s office
Sources of health information
The use of pamphlets as a source of
health information
Patients’ communication with the
physician/medical staff
The questionnaire was distributed in
the period from Spring until Winter
of 2007 through four channels in
Athens (Attica):




A private hospital
A private university
Private physicians practice
A convenience sample from other
sources
N = 105
Regions:
Attica (Athens area) 79%
(83)
Other 15% (16)
Missing info 6% (6)
N = 105
[44 males; 61 females]
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Frequency
80
70
60
50
40
30
20
10
0
Frequency
Doctor visit – Frequency & Reasons
Last 6 months Doc
Visit:




3 or more times – 31%
(32)
1-2 times – 39% (41)
No Other time – 27% (28)
[Missing – 4% (4) ]
Missing
64% visiting a General
Practitioner (“Pathologos”)
Top three health issues that patients
asked their health care providers about
in the last 6 months:
1.
2.
3.
Nutrition (61%)
Oral health (49.5%)
Physical activity (32%)
23% respectively also asked about STDs and Smoking
Knowledge of the Public Health
System
PublicHSknowledge
Valid
Missing
Total
very poor
poor
acceptable
good
Total
System
Frequency
27
22
38
13
100
5
105
Percent
25.7
21.0
36.2
12.4
95.2
4.8
100.0
Valid Percent
27.0
22.0
38.0
13.0
100.0
Cumulative
Percent
27.0
49.0
87.0
100.0
50-50! About half of the respondents feel they have
a “good” or “acceptable” knowledge; other half feel
they have “poor” or “very poor” knowledge
Sources of Health Information
Sometimes/often
Internet
43.50%
Physician
57%
Friends
43%
Family
0
46.50%
Magazines
50.50%
Television
55%
Pharmacist
36%
0%
20%
40%
60%
Sometimes/often
Internet use
Greeks on the whole
do not use the internet
as OECD data shows
that less than 40% of
Greek population uses
the internet.
LISTED SOURCES OF
ADDITIONAL INFORMATION
Frequency
20
Responses
General Survey Comments (not
all inclusive):
“I use doctors to get information
but talk to my friends to gain
from their experience”
“My responses to this survey
only relate to Dr. X”
Percent
Family & Friends
1
1%
Friends & other
Physicians
1
1%
Internet
4
4%
Internet & family
2
2%
Other
2
2%
Other Physician
5
5%
Other Physician &
Family
1
1%
Pharmacist
9
9%
Pharmacist & Family
2
2%
73
73%
105
100.0
BLANK
Total
Women
%
N
Valid
Respns
InfoPharm
InfoTV
52% (55)
InfoMag
56% (59)
52% (55)
InfoDoc
InfoNet
InfoFamily
Infofriends
InfoPamphlets
53% (56)
50.5% (53)
50.5% (53)
51% (54)
49% (51)
sometimes
often
InfoPamphlets
12.5
10.0
Frequency
Women
7.5
5.0
2.5
0.0
not at all
rarely
Men
%
N
InfoPharm
Valid
Respns
38% (40)
InfoTV
InfoMag
InfoDoc
InfoNet
InfoFamily
40% (42)
38% (40)
47% (39)
49.5% (39)
37% (39)
sometimes
often
InfoPamphlets
12
10
8
Frequency
Men
6
4
2
0
not at all
rarely
Infofriends
InfoPamphlets
40% (42)
36% (38)
Health Info from Doctor
Likert Scale
Men (39)
Women (56)
Not at all
3% (1)
2% (1)
Rarely
5% (2)
13% (7)
Sometimes
44% (17)
23% (13)
Often
26% (10)
29% (16)
Always
23% (9)
34% (19)
Info from Pamphlets
InfoPamphlets
12
10
Frequency
8
6
4
2
0
not at all
rarely
sometimes
InfoPamphlets
often
Client- healthcare provider
communication
Communication with Doctor & Medical Personnel


 for Patient - Doctor Communication
– 76% (80) “often” or “always” feel
comfortable talking to their doctor
– 78% (82) “
“ have all their questions
answered
– 72% (76) “
“ understand all info given
– 69% (72) “
“ feel doctor spends enough
time explaining issues
– 73% (77) “
“ feel doctor supports and
understands them
 for Patients feeling supported by other staff
– Staff offers health information – 29.5% (31)
“always” or “often”; 20% (21) “sometimes”
& 25% (26) “rarely”
– Staff is supportive – 40% (42) “always” or “often”;
25% (26) “sometimes” & 17% (18) “rarely”
90.5% of the sample, indicate they
“often” to “always” follow their
doctor’s orders
56% of the sample, “rarely”
to “not at all” ask for additional
information from their physician
Correlations
Correlations by Education level
InfoTV
Education
Spearman's
rho
InfoMag
InfoDoc
-.208(*)
.087
.138
.347(**)
.013
.015
.145
.040
.410
.189
.001
.901
.885
.183
98
92
92
89
89
93
86
Sig. (2-tailed)
N
InfoNet
InfoFamily
Infofriends
InfoPamphlets
* Correlation is significant at the 0.05 level
** Correlation is significant at the 0.01 level
PublicHealthSystem
Knowledge
Education
Spearman's rho
Sig. (2-tailed)
N
* Correlation is significant at the 0.01 level
.263(*)
.009
97
About 17%-20%
of total adult
population in
Greece uses the
internet
Patients who followed their
physician’s directions regarding
medication were also more likely to
ask for additional information
from their physician

Pearson correlation significance
0.447 (at the .001 level).
Discussion
Sources of Health Information
No primary source of health
information could be identified as
pertaining to this sample of adults in
Athens.
It can be deduced that the sampled population
takes in health information from a multitude of
sources, but whether this actually contributes to
a raised level of health literacy has yet to be
determined.
When planning health
campaigns, a balance among
various information outlets
should be utilized
Patient – Health care provider
communication
Data shows that
the client healthcare provider
relationship is
satisfying in our
sample overall, as
participants feel
comfortable and
understood by
their physicians.
3 patients mentioned on their surveys that the information
concerning client physician communication only refers to their
physician and does not refer to their experiences with other
physicians.
Pamphlets


Pamphlets do not seem to be
a major source of health
information though about
half of the respondents
stated that they are able to
acquire pamphlets if needed.
Readers of pamphlets may
further not be educated on
advanced or even basic
medical terms used
(readability/health literacy)
in the pamphlets, thereby
rendering them of little use.
In context



In Greece, pamphlets are
often created by
health or research
institutions
pharmaceutical companies
public health organizations
though their level of
readability in the context
of the public’s health
literacy is questionable.
Limitations
1.
2.
3.
The study is cross-sectional in design
and thus is not predictive in nature.
The generalizability of study findings
may be limited due to the selection
method of the study population and
the limited sample size.
There is no formal way of measuring
health literacy levels in adults existing
in Greece that could be utilized for this
study.
“Patients will need better information if they are going
to improve their lifestyle, manage their disease, and
participate in complex decisions about treatment.”
– Better health-literacy education in schools
– Better-written health materials
– Well-trained educators for patients.
… a great deal could be accomplished if doctors and
other health professionals took time, at the end of
each consultation, to make sure the patient had
understood the key points discussed, and that they
felt free to ask questions.”
Source: “Taking Health Literacy Seriously” Lancet 2005; 366:95
Resources Defining
& Helping Improve Health Literacy
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210-3680900;
www.hau.edu.gr