Jokes about communication breakdowns arising from doctors' poor handwriting and confusing medical jargon may be common, but poor health literacy is no laughing matter for over one million New Zealand adults whom it affects.
In New Zealand, as in many other nations, more than half of adults have difficulty navigating the health system, looking after their health and managing long-term conditions. This has serious and well-documented consequences for health.
The Ministry of Health has defined "health literacy" as being the capacity to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions.
This definition assumes that people receive the right information, that the information is understood and that the person can make an informed decision.
Often health professionals assess people as being non-compliant because they are not making informed decisions, yet the health professionals have not checked that the patients received information that was right for them and that they understood it.
Health literacy has significant implications for people's health and wellbeing, and for the health system itself. People with low health literacy are less likely to use preventative services, effectively manage long-term conditions, and communicate concerns to health professionals. They are also more likely to be hospitalised due to a chronic condition and to use emergency services.
Low health literacy significantly contributes to health disparities for Maori and Pacific peoples, older people, younger people and those with limited education and limited English language proficiency.
But it is not confined to these groups and affects New Zealanders from all walks of life. Even highly literate people commonly find it difficult to understand complex and unfamiliar health information, particularly when diagnosed with a new condition.
A range of factors can influence health literacy, such as familiarity with the health topic and the system, stress levels and confidence in asking questions.
Health literacy is not just the patient's responsibility. The literacy and numeracy demands that the health system places on individuals are a significant influence on the patient's health literacy. Demands range from how health services are designed and delivered, to the complexity of oral and written communication used when providing patients and their families with information and instructions.
For example, poor instructions could result in people taking their medication incorrectly; operating theatres could be lying idle because patients were not given clear information about important pre-operative procedures; or patients might repeatedly require medical assistance because health professionals did not communicate clearly about how to manage chronic conditions such as diabetes or gout.
Producing more pamphlets, brochures and written material will not help either.
Many brochures are a waste of money because they completely miss the mark with their intended audiences. Simply writing things in plain English, or dumbing down or cutting the amount of information is not enough. There is a need to build health literacy knowledge and skills.
Instead of bombarding people with more information, health professionals should look closely at finding ways to better ensure that people truly understand what they have been told and supporting them to take appropriate action. This will involve changing how they talk to and write for the public, and examining health systems to see whether health services and the information about them are accessible and clearly explained.
Health professionals should avoid making assumptions about what patients know and instead take the time to find out what they actually know and then build upon that knowledge.
At every stage they need to ask questions to thoroughly check for understanding (eg, "lots of people have questions about this, what questions do you have?"), rather than simply asking "do you have any questions?".
Patients and communities should be involved, because seeking target audiences' feedback can quickly identify barriers to health literacy.
There is no quick fix for New Zealand's health challenges and the health sector is taking commendable steps to improve New Zealanders' health outcomes.
The best results will be achieved if health professionals and policymakers do more to reduce the health literacy demands being placed on people, and spend time building people's knowledge and skills. Taking these steps will save lives, money and resources.
Susan Reid is consulting manager at Workbase, a charitable trust that supports adult literacy, numeracy and communication.By Susan Reid