Dr Coral Sirdifield of CaHRU contributed to a recent report produced under the EU Health Programme (2008-2013) following completion of the HEALIT4EU project, ‘Study on sound evidence for a better understanding of health literacy in the European Union‘. Prof Niro Siriwardena, director of CaHRU, is UK coordinator of the EPHORT consortium led by the Netherlands Institute for Health Services Research which provides commissioned reports to the EU under this programme.
The authors describe health literacy as enabling “people to make judgements and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve their quality of life”, and state that it can be seen as encompassing not only an individual skill, but also an individual’s social support system and the context within which they are using basic, communicative and critical literacy skills. Health literacy is a multidimensional concept which incorporates the ability to understand, use, interact with and critically evaluate health information and services and to actively manage personal health in the context of one’s social network and the healthcare system. Poor health literacy is associated with worse health outcomes despite higher health care service use and is an important factor in health inequalities.
The report maps health literacy interventions in an EU context, and existing policies and actions aimed at improving health literacy in EU member states. The authors also developed prediction models around determining health literacy using publicly available information sources. Information around health literacy policy and practice in the UK was supplied by Prof Siriwardena and Dr Sirdifield from the University of Lincoln.
The main recommendations of the research are as follows:
“Interventions:
- More attention should be given to the development and evaluation of health literacy interventions in a European context, using research designs which have sufficiently scientific rigour and which include cost-effectiveness in their design.
Research:
- There is a need for agreement among researchers on valid measurement tools for health literacy in a European context, and more systematic use of validated, preferably comprehensive, measurement tools in interventions.
- Health literacy research funding should give more attention to (a) the quality of the studies and (b) the need for specific kind of evidence, such as: intervention studies, effectiveness and cost-effectiveness, and international comparative research.
Policy:
- Though health literacy is on the agenda in most of the EU Member States, in many countries the efforts are not coordinated through a policy at the most appropriate level. A more programmatic and evidence-based policy to health literacy in individual EU Member States and further exchanges of knowledge and best-practices at EU level could be beneficial with regard to the outcomes of these efforts.
- The concept of ‘health literacy’ can be considered a useful complement to more general health promotion and education policies, as it enables to better tailor health promotion and education approaches to individuals or populations with low literacy and increase the effectiveness of such policies.
- Policies on health literacy should also address the context in which people have to be “health literate” – this is the health care system itself, how providers deliver care, how services are organised, how health information is provided, etc. In addition, from a public health perspective health literacy policies should be implemented in other relevant contexts such as the education system and at the workplace. However, most of the current interventions and programmes do not seem to focus on the context. Instead, they seem to focus on individuals, or groups ‘at risk’, or people with low health literacy skills.”
The report recommends that more attention should be given to the development and evaluation of well-designed health literacy interventions in Europe context which include cost-effectiveness analyses and valid tools for measuring health literacy. In terms of policy the report recommends that EU Member States support evidence-based policy towards health literacy and exchange knowledge and best-practice; include health literacy to complement health promotion and education policies; and address the healthcare context for health literacy in terms of the health system, care provision, service organisation, and health information together with other relevant contexts such as the education system and the workplace.
Coral Sirdifield
One of the few studies of service user involvement in a clinical trials was published this month in the journal Trials: ‘Involving older people in a multi-centre randomised trial of a complex intervention in pre-hospital emergency care: implementation of a collaborative model‘. The study was part of the SAFER2 (Support and Assessment for Fall Emergency Referrals) trial led by the University of Swansea with Ambulance Services in the East Midlands, London and Wales and involving CaHRU at the University of Lincoln. The study was led by Bridie Evans and the trial lead was Prof Helen Snooks, both from Swansea University.
The study describes how it was planned for service users to be involved in the trial and how involvement actually occurred. The study team planned for service users to be involved at strategic level, at each study site and locally and this did take place. For example at strategic level, service users were involved in the trial management, 
trial steering, and data monitoring and ethics committees In addition, service users were also involved in study writing days and task and finish groups. Service users were also involved at study sites. Finally, service user reference groups were consulted at various points during the study.
