Exploring the facilitators and barriers to meeting older adults' health literacy needs in clinical practice

Background and aim Health literacy is a term used to describe the ability of individuals to access, understand and use health information. Lower health literacy levels are associated with increased mortality and morbidity, and are more prevalent in older adult populations. UK NHS policy advocates meaningful patient engagement in healthcare. Vital health information is often inaccessible and older adults are not always sufficiently supported by healthcare providers to meaningfully engage with healthcare decisions. There is little research in this area. This research aimed to identify facilitators and barriers to meeting older adults’ health literacy needs in clinical practice, from patients’ and healthcare providers’ perspectives. Methods This research comprised two discrete but interconnecting phases; the findings from the first phase led to the development of the second. The first phase involved conducting semi-structured interviews with nine older adults (aged 65 years and over) attending a falls clinic in the South of England. Participants’ health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine and the Newest Vital Sign-UK. Interviews explored older adults’ views and experiences about access to the service, provider-patient interaction and self-management. Interpretative phenomenological analysis was used to interrogate the data. The second phase involved four focus groups with 22 healthcare providers working with older adults, and explored views about meeting older adults’ health literacy needs. Framework analysis was applied to the focus group data. Findings Both phases of the research revealed the importance of building relationships and trust, tailoring healthcare information to individuals’ needs and social support when meeting older adults’ health literacy needs. Limitations or concerns about the use of health literacy screening were also identified in both phases. All older adult participants emphasised the importance of clear and simple communication; contrastingly, the healthcare providers expressed strong reservations about using ‘universal precautions’ with all patients. Healthcare providers also had low awareness about health literacy and appeared to shift the responsibility for development of health literacy onto public health and education sectors. Conclusion and implications for clinical practice The findings corroborate other research emphasising the essential role of face-to-face interactions in meeting older adults’ health literacy needs and recognising health literacy as an interaction between individuals’ personal capabilities and the demands of healthcare systems. This research uniquely identifies issues with the transference of the holistic health literacy concept to a UK healthcare setting, such as healthcare providers viewing health literacy as a static risk and shifting responsibility for development of health literacy onto public health and education sectors. This is the first study to qualitatively compare health literacy screening and universal precautions from healthcare providers’ and older adults’ perspectives, revealing practical and emotional issues with both approaches. The research also reinforces the importance of trust, tailoring interactions to older adults’ unique attributes and goals and preferred learning and communication styles and social support. To engage older adults meaningfully in their healthcare, healthcare providers need support to develop their skills to meet their patients’ health literacy needs. The findings also highlight that further research is needed to develop effective health literacy interventions for older adults and to ascertain the acceptability and utility of using health literacy screening or universal precautions with older adult patients.