The importance of health literacy in the development of ‘Self Care’ cards for community pharmacies in Ireland
Objectives: ‘Self Care’ cards play a significant role in delivering health education via community pharmacies in Australia and New Zealand. The primary objective of this study was to evaluate whether such an initiative could have a similar impact in an Irish context. The secondary objective was to understand the importance of health literacy to this initiative.
Methods: Ten cards were developed for the Irish healthcare setting and trialed as a proof of concept study. The pilot study ran in ten community pharmacies in the greater Cork area for a six-month period. Using a mixed methods approach (Questionnaires & focus group) staff and patient reactions to the initiative were obtained. Concurrent to the pilot study, readability scores of cards (Flesch-Kincaid, Fry, SMOG methods) and the Rapid Estimate of Adult Literacy in Medicine (REALM) health literacy screening tool was administered to a sample of patients.
Results: 88.7% of patient respondents (n=53) liked the concept of the ‘Self Care’ cards and 83% of respondents agreed that the use of the card was beneficial to their understanding of their ailment. Focus groups with Pharmacy staff highlighted the importance of appropriate training for the future development of this initiative. An emerging theme from designing the cards was health literacy. The pilot ‘Self Care’ cards were pitched at too high a literacy level for the general Irish public to understand as determined by readability score methods. It was found that 19.1% of a sample population (n=199) was deemed to have low health literacy skills.
Conclusion: The ‘Self Care’ initiative has the potential to be Pharmacy’s contribution to health education in Ireland. The initiative needs to be cognizant of the health literacy framework that equates the skills of individuals to the demands placed upon them.
2. Pharmaceutical Society of Australia - Self Care. 2012. Available from: http://www.psa.org.au/ (Accessed 15th February 2012)
3. Department of Education and Science (1997). International Adult Literacy Survey: Results for Ireland. Dublin: Stationary Office;
4. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H; (HLS-EU) Consortium Health Literacy Project European. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.
5. National Health and Lifestyle Surveys : survey of lifestyle attitudes and nutrition (SLÁN) and the Irish health behaviour in school-aged children survey (HBSC) . Available from: http://www.dohc.ie/publications/national_health_and_lifestyle_surveys.html (Accessed 15th February 2012)
6. www.healthliteracy.ie. EU Health Literacy Survey Results announced today | Health Literacy 2011 Available from: http://healthliteracy.ie/four-out-of-10-people-in-ireland-have-low-health-literacy/ (Accessed 13th February 2012)
7. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107.
8. Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, Crouch MA. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25(6):391-395.
9. NALA, (2005). Plain English Guidelines. Available from: http://www.nala.ie/index.cfm/section/publications/top/1/ext/Publications/search_pub/1/ (Accessed 13th February 2012)
10. Flesch RF. A new readability yardstick. Journal of Applied Psychology. 1948;32:221-533.
11. Fry E. A readability formula that saves time. Journal of Reading. 1968;11(7):513-516, 575-578.
12. McLaughlin, GW. SMOG Grading: A new readability formula. Journal of Reading 1969;12(8):639-646.
13. Shea JA, Beers BB, McDonald VJ, Quistberg DA, Ravenell KL, Asch DA. Assessing health literacy in African American and Caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores. Fam Med. 2004;36(8):575-581.
14. Measures of Health Literacy. Workshop Summary - Institute of Medicine. Available from: http://iom.edu/Reports/2009/Measures-of-Health-Literacy.aspx (Accessed 13th February 2012)
15. Layton D, Sinclair HK, Bond CM, Hannaford PC, Shakir SAW. Pharmacovigilance of over-the-counter products based in community pharmacy: methodological issues from pilot work conducted in Hampshire and Grampian, UK. Pharmacoepidemiol Drug Saf. 2002 Sep;11(6):503-513.
16. Hamilton, A. An evaluation of the extended role of the community pharmacist in rural areas of West Ireland. Journal of Social and Administrative Pharmacy. 1998;15:42-49.
17. HSE's Primary Care Strategy. Available from: http://www.hse.ie/eng/Staff/FactFile/HSE_Approach/Primary, Community_and_Continuing_Care/Primary_Care/Primary_Care.html (Accessed 13th February 2012)
18. Eades CE, Ferguson JS, O’Carroll RE. Public health in community pharmacy: a systematic review of pharmacist and consumer views. BMC Public Health. 2011;11:582.
19. NALA, (2009). NALA Policy Brief on Health Literacy in Ireland. Dublin: NALA; 2009 Sep. Available from: http://www.nala.ie/index.cfm/section/publications/top/1/ext/Publications/search_pub/1/Type_of_publication_key/0/search_text/Health%20Literacy/page/2 (Accessed 13th February 2012)
20. Doak C, Doak L, Root H. Teaching Patients with Low Literacy Skills. 2nd ed. Philadelphia: Lippincott; 1996.
21. Medicines and Healthcare products Regulatory Agency’s (MHRA) Committee of Safety of Medicine (CSM) Working Group on Patient Information (2005). Always read the leaflet – getting the best information with every medicine. London.: The Stationary Office.
22. Raynor DK, Blenkinsopp A, Knapp P, Grime J, Nicolson DJ, Pollock K, Dorer G, Gilbody S, Dickinson D, Maule AJ, Spoor P. A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. Health Technol Assess. 2007 Feb;11(5):iii, 1-160.
23. Porteous T, Ryan M, Bond CM, Hannaford P. Preferences for self-care or professional advice for minor illness: a discrete choice experiment. Br J Gen Pract. 2006;56(533):911-917.
24. Ibrahim SY, Reid F, Shaw A, Rowlands G, Gomez GB, Chesnokov M, Ussher M. Validation of a health literacy screening tool (REALM) in a UK population with coronary heart disease. J Public Health (Oxf). 2008;30(4):449-455.
25. Gordon M-M, Hampson R, Capell HA, Madhok R. Illiteracy in rheumatoid arthritis patients as determined by the Rapid Estimate of Adult Literacy in Medicine (REALM) score. Rheumatology (Oxf). 2002;41(7):750-754.
26. Ratzan SC. The national health literacy action plan: the time has come for action. J Health Commun. 2010;15(6):575-577.
27. European Parliament hosts debate on health literacy. 2010. Available from: http://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f-77d4-4ad8-b6d6-bf0f23083f30&ID=892&RootFolder=%2Fen%2Factivities%2Fsciadvice%2FLists%2FECDC%20Reviews (Accessed 12th February 2012)
28. Department of Health. 2007. Health inequalities - progress and next steps. Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085307 (Accessed 12th February 2012)
29. King SR, McCaffrey DJ, Bouldin AS. Health literacy in the pharmacy setting: defining pharmacotherapy literacy. Pharm Pract. 2011;9(4):213-220