Forget career studies, we need to teach health literacy in schools

[Annette McKinnon]

Here's an opinion piece from today's Toronto Star Annette

Forget career studies, we need to teach health literacy in schools

Some baseline knowledge of what to expect, and the capacity to ask the right questions and understand the answers, would go a long way to allaying the fears that accompany medical visits.

ST

By Sophie Taché-GreenContributor
Mon., Jan. 10, 2022timer3 min. read

Last week my friend texted me from the hospital. I am an ER nurse and have guided him through many of his health-care encounters. But this text was not asking for guidance: “Oh my god! They think I’m a nurse!”
One should not have to be a nurse (or have one on speed dial) to understand the health-care system. And yet when my aunt called me last month after a hospital visit, she was unable to tell me why she was prescribed antibiotics. A friend who was in the ER for a concussion around that same time was unsure if he had seen a doctor. “I saw someone,” he told me. “They said it was all right for me to leave.”
At work, I cannot count the number of times that I have gone to discharge a patient only to find them unaware that they are being sent home. I have triaged hundreds of patients returning just days (or hours!) after leaving the hospital because they did not understand their discharge instructions. Unnecessary returns waste resources and misunderstood discharges are dangerous. What happens when patients do not understand indications to return and their conditions deteriorate?
Yes, we need improved discharge protocols. But understanding diagnosis and discharge are only part of a much larger health literacy problem.
Say you or a loved one is sick. What should you do? A doctor friend told me about a woman who, despite being born and raised in Toronto, did not know she could access free health care after a sports injury. And even when you do know what universal health-care entails, where do you go? Family doctor? Clinic? ER? What do you do when you get there? In my ER, everyone from housekeeping to the chief of staff wears the same scrubs, so who do you talk to?
In Ontario, I was taught “career studies” in Grade 10. I studied mortgage rates in math class. But I learned nothing about our health-care system. A person may never work or buy property. But eventual dealings with the health-care system are inevitable for us all.
We need to include health literacy in our high school curricula. Canadians should be taught the meaning and scope of universal health-care, where to go when they are sick, what to expect when they get there, and how to make relevant inquiries to facilitate their care.
The Centers for Disease Control and Prevention says improved health literacy could prevent almost a million U.S. hospital visits each year. Education is the path to improved literacy.
A health literacy course would arm students with an understanding of the system, teach them how and when to access it, and introduce entry-level health concepts, thereby empowering them to become contributing partners in their care. This, in turn, could improve health outcomes, reduce health-care spending, and allow providers to focus more on providing and less on tour guiding.
Sophie Taché-Green is an ER and ICU nurse currently pursuing a masters in nursing at McGill University.

[Janet Costa]

What a great interesting and bang on read this is, there is so much we should teach in schools instead of some of the old information students are still getting.
Learning about healthcare in school adding to the education of everyone would leave far fewer people engaging with the system and trying to work out what is happening to them and who is involved in their care,then the patient becomes the center of their own care which is the plan for Patient and family centered care.

[John Sherber]

A few thoughts:
If care is a partnership and a partnership is the meeting of equals what is the patient bringing to the relationship?
Patient Activation: “An individual’s knowledge, skill and confidence for managing their health and their health care”.
Their is a PAM measurement
https://patientengagementhit.com/news/what-is-the-patient-activation-measure-in-patient-centered-care that measures this.
We could help our system and so many people by being engaged.
The lack of awareness of "our" health is truly unparalleled. This story suggests why? No one teaches the youth, the masses about what their "responsibility" is when it comes to understanding what it takes to live a healthy life. We have to take a test to drive because it affects us and everyone around us.
Our health care system is in free fall and the volume of persons going into to it:
CIHI stats states a 68% increase in persons 75 and over in the next 20 years with a workforce going from a ration of 8/1 down to 4/1. Our youth need info to assist them for the future. This is a super idea!!!! What do you want for your future? For your children your grandchildren
Respectfully,
John

[Alies Maybee]

Love this conversation! YES and YES we need better health and also digital health literacy at all levels. I would argue we should be starting in kindergarten with the healthy choices and exercise stuff. Young kids who understood about smoking's effect on the lungs (mine as an example) learn at 12 or so and then they lobby their smoking parents -- usually successfully. Who can say "no" to their kids?

And in high school, we need basic life skills, financial literacy and definitely health literacy including all the stuff listed in the article above. If the teenagers understand more about the system, they can guide parents and grandparents. What a win that would be? So what ideas are there to get this on the curriculum? Are there examples anywhere in Canada? Should some of us put together a webinar to offer to schools? Thoughts, folks, ideas. Does anyone want to spearhead this as a project? Who wants to join in?

[Carolyn Canfield]

Here's another idea: what about a trained, supervised, supported and paid youth and citizen "job corps" to serve as patient navigators for the vast numbers of people who cannot guide themselves through healthcare. The guides would learn so much for their future, including when to ask for help. The guided would receive much more coordinated and timely care (even picking up prescriptions and escorts to appointments would be awesome). Much of the work would be simple with complex or complicated issues to be escalated immediately for continued partnership with a specialist navigator (retired healthcare worker?). Pie in the sky? Maybe no. The costs of letting us fumble our way when we are most stressed and compromised would seem to be much much less tolerable. Just musing on optimistic possibilities.

[Kathy Smith]

Discharge drop off is a huge patient safety concern. It has occurred more than once in my family. I believe there should be specially trained discharge RNs(?) who

[Kathy Smith]

(Continued) RNs who co-ordinate all aspects of a safe hand off to home: Meds, appointments, special instructions, home-care and equipment coordination… The plan should be reviewed with the care partner at least hours (preferably a day) ahead of discharge. Concerns can then be addressed in a safe and timely manner. Volunteers (retirees? PFAs?) could be trained to then make a follow-up wellness call within the next two days following a discharge - using a prepared list of relevant questions. Any red flags would trigger further followup action.

[Alies Maybee]

Carolyn, love the idea of high school students and youth being navigators. It could be the volunteer component of a high school program perhaps. It would also be a way of educating young people to the challenges and issues people face with the health and with the system.

[Troy Stooke]

This is what we've been working on for 7 years in Alberta. It is not so easy to influence provincial curriculum in our province. I More chances with individual teachers/principals...
These two links https://myhealth.alberta.ca/HealthTopics/iKNOW-Health and iKNOW Health – Imagine Citizens Network will give an idea of the generalities of where we're at. ICN and the two youth councils with the pediatric hospitals here held a youth digital health literacy session last spring to help inform a path forward. It was well received. Youth are asking for lots of mental health literacy info fyi. No surprise there. I'd be interested in having a conversation with a few others engaged with youth already, about this with a hope to emerge from such a meeting with specific strategies for sharing/adapting our findings/materials to date with other youth groups/settings besides schools and hospitals.

[Pamela Stoikopoulos]

Great discussion and ideas. I'd also note that health care professionals sometimes don't understand the system. While in recovery for an operation, I received pretty vague info from a hospital nurse re. home care follow-up. I worked in home care so I knew more of the ins and outs, however, it was clear she didn't have a clue how it worked.

I'm all-in for patient navigators! Great idea to have student volunteers. Additionally what about infographic -based take-aways for patients for their instructions? They could have images and tick boxes. Heck I'd like to see leave behind cards with job descriptions. I.e. "My name is ______. I am an occupational therapist. I do xy and z. When you're receiving care sometimes it's hard to keep who is who straight, especially where there is a parade of health workers visiting you at home or in hospital. A little "calling card" might help (or put it on the back of a biz card).

And yes, health literacy would be a great option for schools (and also a good way to promote health care jobs as a future career possibility).

[John Sherber]

Sophie, thank you for generating this conversation. It has brought a lot of areas that can be brought together. I do love the ideas of bringing young people into our system. We used to have, "Candy Strippers". I believe there role was to keep patients feeling comfortable and do some small jobs. My point now! I think our system has changed in a way that it would be hard to get a program going with students. Privacy, access, rules and regs have become the norm.
Take the statement talked about in this thread. Someone was being taught about mortgages but nothing about HC. Can we build on this? Since education is provincial but in (BC) it is a school board that makes a lot of decisions about curriculum.
How do we tailor a message that can go to these bureaucrats? If we do it across the country or find someone who is maybe we can make a difference?
This video shows what has happened to us over time. Our children need education in this area.
https://www.facebook.com/watch/?ref=external&v=936382627201461

[Alies Maybee]

Pam and John and everyone else, great ideas. There are more and more of us talking about this issue so we will find a way to have us all meet and see what we can do further. Stay tuned.

[Annette McKinnon]

Happy to see the ideas and I noticed a research abstract today that I thought was interesting in this context. I liked the way they listed the processes that were helpful.

Sykes, S.; Wills, J.; Popple, K.The role of community development in building critical health literacy
Community Development Journal Oct 2018;53(4):751-7672018 Oct
DOI:10.1093/cdj/bsx019
There is growing international interest in health literacy and the processes by which it can be developed. Critical health literacy, one of the domains of health literacy, shows an affinity with the goals and processes of community development. Critical health literacy represents a cognitive and personal skill set that exists at either individual or community level and which is oriented towards social and political action on factors affecting health.

This article examines the relationship between critical health literacy and community development. Using an illustrative case study it explores the extent to which community development processes were used by a project to build critical health literacy amongst vulnerable populations and communities.

The case study demonstrates that in working to build the different elements of critical health literacy processes were used that were typical of community development. These processes included building self-efficacy and self-esteem, participatory and mutual learning techniques, acquisition of technical, practical and emancipatory knowledge, democratic processes of collective decision making, critical questioning, critical awareness raising and conscientization.

The article argues for community development to embrace and advance the concept of critical health literacy in order that; its potential to address inequalities in health can be achieved and to create an opportunity to embed community development more fully within health policy and practice.

Annette