CaHRU contributes to report on a better understanding of health literacy in the European Union

coralDr 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.

Netherlands Institute for Health Services ResearchThe 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:


  • 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.


  • 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.


  • 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

CAHRU at the College of Social Science Summer Conference

IMG-20150703-WA0002CaHRU members, Viet-Hai Phung, Ana Godoy and Dr Jo Middlemass all presented posters at the recent College of Social Science Summer Conference, held at the University of Lincoln Business School on Thursday 2nd July. The purpose of the Conference was to showcase a range of work from across the College of Social Science that had been funded by its small grants scheme.

IMG-20150703-WA0000Ana was busiest as she presented four posters: Resources for Effective Sleep Treatment utilising Community Pharmacists (REST-UP), bisphosphonates and stroke and two for Quality and Costs of Primary Care in Europe (QUALICOPC)! Jo and Viet-Hai presented their work on dementia and ethnic inequalities in prehospital care respectively. All six posters generated considerable interest from attendees. Research from the wider School of Health and Social Care was also very well represented. Alongside the poster sessions were three sessions with 20 oral presentations from PhD students and staff. As with the posters, the oral presentations captured the diversity of the College’s work: from the work of the Red Cross to the future of Christmas markets; from gender identities and football through to the psychology of decision-making; from empathy in nursing to branding cities.

Viet-Hai_posterIt is sometimes felt that students and academics rarely know what research colleagues in other parts of a School or College do. If the university is serious about raising awareness about the work of different departments, schools and colleges, then events such as this should become a permanent fixture in the academic calendar.

Viet-Hai Phung

CaHRU Spring 2015 Newsletter

[su_document url=”” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

The latest edition of the CaHRU Newsletter (Spring 2015) was published this week. The newsletter presents the work of the research centre over the previous three months and includes articles from the CaHRU blog covering publications, conferences and funding. The newsletter is produced by Sue Bowler, CaHRU administrator.

Ethnicity and prehospital emergency care briefing paper published

EMAS - A&E 5_750A new briefing paper, ‘Ethnicity and prehospital emergency care provided by ambulance services‘, was published today by The Race Equality Foundation. The paper was co-authored by Viet-Hai Phung, Professor Niro Siriwardena, and Dr Zahid Asghar from CaHRU and Dr Karen Windle from the School of Health and Social Care.

EMAS - A&E 7_750It builds on work that CaHRU is undertaking on people from minority groups and their prehospital care. The briefing paper describes the inequalities in access to, as well as treatment and outcomes from, prehospital care for minority ethnic groups in the UK. It discusses how inequalities are driven by factors that include limited cultural awareness among service providers, as well as limited language proficiency and understanding of the healthcare system among these patients groups and how these inequalities manifest themselves in differences in treatment and outcomes.

EMAS - A&E 9_750The paper goes on to examine the implications arising from these inequalities for service delivery, especially since increasing ethnic diversity is raising issues of equality and equity higher up the legislative and policy agendas. It concludes by exploring potential solutions, which include: a more integrated approach to collecting patient ethnicity data; interventions that target at-risk groups in particular locations; and better cultural competency training for service providers.

Viet-Hai Phung

New systematic review published on interventions to reduce risk of overweight and obesity in infancy and childhood

A new study has been published by led by Prof Sarah Redsell of Anglia Ruskin University and a team of researchers at the Universities of Cambridge, Nottingham and Lincoln, including Prof Niro Siriwardena of CaHRU. The study, published in Maternal and Child Nutrition, was entitled ‘Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood’.

<This new review sought to identify randomised controlled trials of interventions delivered antenatally or during the first 2 years of life and designed to reduce the risk of overweight/obesity from birth to seven years of age. The authors identified 35 eligible studies published from January 1990 to September 2013 in six electronic databases. This included 27 unique trials of interventions including nutritional and/or responsive feeding, breastfeeding promotion and lactation support for mothers, parenting and family lifestyle, maternal health changing formula milk composition or diet, and modifying parental responsiveness to infant cues. The interventions had variable effects on feeding practices, behaviour and weight in infancy or childhood.

There were few intervention studies for pregnant women that continued during infancy. The authors are developing and testing the feasibility of a complex intervention comprising an interactive, educational programme (ProAsk) for health practitioners to guide and enhance communication with parents of infants about obesity risk identification and prevention strategies, funded by the Medical Research Council.