Lambert Michelle, Luke Joanne, Downey Bernice, Crengle Sue, Kelaher Margaret, Reid Susan, Smylie Janet
BMC Health Serv Res. 2014 Nov 29;14:614. doi: 10.1186/s12913-014-0614-1.
Despite the growing interest in health literacy, little research has been done around health professionals' knowledge of health literacy or understandings of the barriers to health literacy that patients face when navigating the health care system. Indigenous peoples in New Zealand (NZ), Canada and Australia experience numerous inequalities in health status and outcomes and international evidence reveals that Indigenous, minority, and socio-economically disadvantaged populations have greater literacy needs. To address concerns in Indigenous health literacy, a two-pronged approach inclusive of both education of health professionals, and structural reform reducing demands the system places on Indigenous patients, are important steps towards reducing these inequalities.
Four Indigenous health care services were involved in the study. Interviews and one focus group were employed to explore the experiences of health professionals working with patients who had experienced cardiovascular disease (CVD) and were taking medications to prevent future events. A thematic analysis was completed and these insights were used in the development of an intervention that was tested as phase two of the study.
Analysis of the data identified ten common themes. This paper concentrates on health professionals' understanding of health literacy and perceptions of barriers that their patients face when accessing healthcare. Health professionals' concepts of health literacy varied and were associated with their perceptions of the barriers that their patients face when attempting to build health literacy skills. These concepts ranged from definitions of health literacy that were focussed on patient deficit to broader definitions that focussed on both patients and the health system. All participants identified a combination of cultural, social and systemic barriers as impediments to their Indigenous patients improving their health literacy knowledge and practices.
This study suggests that health professionals have a limited understanding of health literacy and of the consequences of low health literacy for their Indigenous patients. This lack of understanding combined with the perceived barriers to improving health literacy limit health professionals' ability to improve their Indigenous patients' health literacy skills and may limit patients' capacity to improve understanding of their illness and instructions on how to manage their health condition/s.
尽管人们对健康素养的兴趣日益浓厚,但针对医疗专业人员对健康素养的了解,以及对患者在医疗系统中获取医疗服务时所面临的健康素养障碍的理解,相关研究却很少。新西兰(NZ)、加拿大和澳大利亚的原住民在健康状况和健康结果方面存在诸多不平等,国际证据表明,原住民、少数族裔和社会经济弱势群体有更大的素养需求。为解决原住民健康素养方面的问题,采取双管齐下的方法,包括对医疗专业人员进行教育,以及进行结构改革以减少医疗系统对原住民患者的要求,是减少这些不平等现象的重要步骤。
四项原住民医疗服务机构参与了该研究。通过访谈和一次焦点小组讨论,探讨了医疗专业人员与患有心血管疾病(CVD)并正在服用药物预防未来发病的患者打交道的经历。完成了主题分析,并将这些见解用于开发一项干预措施,该干预措施在研究的第二阶段进行了测试。
对数据的分析确定了十个共同主题。本文重点关注医疗专业人员对健康素养的理解,以及他们对患者在获取医疗服务时所面临障碍的看法。医疗专业人员对健康素养的概念各不相同,并且与他们对患者在尝试培养健康素养技能时所面临障碍的看法相关。这些概念范围从侧重于患者缺陷的健康素养定义到侧重于患者和医疗系统的更广泛定义。所有参与者都认为文化、社会和系统障碍的综合作用阻碍了他们的原住民患者提高健康素养知识和实践能力。
本研究表明,医疗专业人员对健康素养以及低健康素养对其原住民患者的影响了解有限。这种缺乏了解,再加上提高健康素养方面存在的明显障碍,限制了医疗专业人员提高其原住民患者健康素养技能的能力,可能还会限制患者增进对自身疾病的理解以及如何管理自身健康状况的指导说明的能力。