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Flashcards in Adherence to Medical Advice Deck (31):

Understand the size of the problem of non-adherence.



Differentiate between intentional and non-intentional non-adherence.



Describe beliefs related to non-adherence.



Describe ways in which clinicians can improve adherence.



What do we mean by 'basic skills'?

The ability to read, write and speak in English and use mathematics at a level necessary to function and progress at work and in society in general.


Give the WHO definition of health literacy.
Why is it important?

The cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health.
It is necessary to improve people’s access to and understanding of health information and their capacity to use it effectively to support improved health.


The risk of poor health literacy is strongly linked to...?

Low educational attainment and low general skills


In 2010, how many % of school leavers left school with five A*-Cs?



How many % of England's adult population have literacy skills before Level 2 (GCSE)?
Why is this significant?

Over half
This is the level of skills needed to discuss a condition interactively with a doctor or specialist.


Give some more figures about adult literacy in England. (4)

Only 25% are able to calculate BMI with a formula or estimate food groups needed for a balanced diet.
1 in 5 adults of working age cannot find a plumber in the Yellow Pages or read the instructions on a medicine bottle.
1 in 4 adults has difficulty calculating the change due from a simple purchase at the corner shop.
4-10% could be described as dyslexic.


Why the emphasis on basic skills?

We need to make sure that people are not socially excluded through their lack of basic skills - this leads to poor health, as it impacts on their ability to make informed health and lifestyle choices and navigate the healthcare system.


What problems may patients have with literacy? (7)

-Reading about the condition
-Writing - e.g. diaries, records, writing questions before consultations, forms
-Not understanding medical jargon
-Needing to communicating with other HPs - lack vocab, unable to assert themselves, no time to explain things in detail
-Slow processing speed
-Cultural issues - different expectations about face-to-face contact, impolite to question someone of higher social status, need to appear to understand (even if they don't)


How can you help your patients understand? (3)

-Use LAY TERMS, only specialist terminology only where there is a need
-Pronounce the term and point to it if you have visual resources to hand
-Allow time for the patient to process your questions and for them to formulate their own


What is meant by the digital divide and why is this relevant?

48% of men and 40% of women with entry level 2 literacy did not have a computer (and 62% didn't have internet access), compared with 16% of men and 17% of women with Level 1 or higher literacy (25% didn't have internet access).
There are huge implications here for health education.


What are the challenges with e-learning? (8)

-Each patient has very different needs and interests
-Not all patients have the independent study skills required to access information
-Not all patients learn best through self-access
-Technical difficulties
-Little interaction with others (no social learning)
-Silent (can't hear the language used or ask questions, i.e. interactivity can be limited)
-Relies heavily on reading
-No one available to support them if they get confused
-Evaluative skills with respect to web sources can be under-developed


What are the benefits of e-learning? (2)

-Many people are motivated to learn through and with ICT
-‘No one laughs at you on the internet’.


Design tips/suggestions for Health Education Materials Design. (9)

- Use plenty of white space - short, clearly separated chunks of text
- Leading – spacing between lines is important (not too close or too far apart)
- Headings and new sections at the top of the page, and don't run sentences/paragraphs over columns or pages. Lines between columns. Clear page numbering.
- Ensure there is no ‘shadowing’ from text over the page.
- Use a soft background colour for web-based materials (avoid darker colours)
- Choose a clear and distinct font
- Upper and lower case (not just upper case)
- Embolden text/enclose it in a box to show importance
- Use diagrams, charts, illustrations (make sure it relates directly to the text to act as a clue)


Tips for readability. (3)

- Sentence length (short, with one or two clauses and one main point)
- Use the active voice rather than the passive
- Limit the number of words with three or more syllables


What is the Fog Index?

A readability test designed to show how easy or difficult a text is to read.


What formula does the Fog Index use?
What is the resulting number?

Reading Level (Grade) = (Average No. of words in sentences + Percentage of words of three or more syllables) x 0.4
Gunning Fog Index


What is meant by Gunning Fog Index?
What is it for...
-New York Times?
-Technical documentation
-Professional prose

Gives the number of years of education that your reader hypothetically needs to understand the paragraph or text.

- 11 to 12
- 10 to 15
- Never exceeds 18


What are the steps of the SMOG readability formula?

Step 1: Take the entire text to be assessed.
Step 2: Count 10 sentences in a row near the beginning, 10 in the middle, and 10 in the end for a total of 30 sentences.
Step 3: Count every word with three or more syllables in each group of sentences, even if the same word appears more than once.
Step 4: Calculate the square root of the number arrived at in Step 3 and round it off to nearest 10.
Step 5: Add 3 to the figure arrived at in Step 4 to know the SMOG Grade.


What is meant by SMOG grade?

The reading grade that a person must have reached if they are to understand fully the text assessed.


What is the SMOG grade formula?

SMOG grade = 3 + Square Root of Polysyllable Count


What is method of estimating adult literacy?

REALM-SF (rapid estimate of adult literacy in medicine – short form)


Summarise the findings of research on low health literacy. (5)

- No cure means that interest is lost in self-management ("cure or nothing" approach as a cultural norm)
- Lower levels of literacy act as another barrier to accessing care (although they didn't identify it as such)
- Participants had had minimal or no services to address symptoms; reliance on medication adherence
- Patient avoidance and anxiety
- Low health and life expectations


What are the drivers of health literacy? (6)

-Little service provision
-Reliance on medication alone
-Lack of access of services and clear pathways between
-The prevailing view that nothing can be done
-The focus on a cure
-Passive acceptance of all of this


What are the principles of intervention? (4)

- Plain English resources
- Acknowledge and strengthen social networks for community support
- Symptomatic relief (address major concerns such as pain and functional ability)
- Inter-sectoral collaboration


Who needs low levels of support?

High literacy, high SES, high social support, no comorbidities, resourced environment, those in private care or single point of contact, less than one year from diagnosis


Who needs high levels of support?

Low literacy, low SES, low social support (e.g lives alone, no family support), 2+ comorbidities, deprived environment, in hospital/multiple points of contact/GP, 2+ years since diagnosis


How can HPs help? (6)

Literacy strategies in plain English and disseminate resources
Emphasis on living with condition, multi-focus on cure and living with condition through symptomatic relief
Referral to chronic pain clinics
Clear pathways between primary and secondary care
Inter-sectonal collaboration