Blythe Robertson: January 28, 2020
In our latest blog, Blythe Robertson, General Manager for Policy and Partnerships in NDS, talks about why we need to consider health literacy when developing digital solutions for people's health and care.
Before joining the NDS team in mid-2019, I had a lengthy stint working for the Scottish Government. My last role there was as the lead for health literacy. I worked to implement the first national action plan, Making it Easy, then developed the second, Making it Easier.
One issue that was briefly explored in both was the relationship between health literacy and digital literacy. Since joining NDS, it has become clear that this is an important area for us to better understand.
Health literacy is about having the skills and confidence to interact with health information and services. Digital literacy is about having the skills to engage with information through digital solutions. Digital health literacy might simply focus the digital information to the healthcare domain, but this glosses-over the potential complexity of the interaction between the two literacies.
Health literacy is a strong determinant of health inequalities – being able to obtain and process health information affects a person’s ability to make healthy choices. Put more positively, if you address health literacy you can reduce inequalities. Being clearer about information, designing spaces that are easier to navigate, and supporting people with tasks that are predictably complicated for everyone (filling in forms etc) will make access to services and information fairer.
The irony is not lost on me that the terms – and the ways to explain them – are sometimes not as clear as they could be. That’s why we were keen to tell the health literacy story in pictures. The Making it Easy images (below) have been widely used across global healthcare settings as a good summary of the challenge.
The health and care system presents people with barriers – often due to the system or the information describing it being too complex. Previous efforts to educate people to leap over the barriers have proved quite ineffective…
…so, the Scottish approach to health literacy is to place the emphasis on practitioners across the health and care system to work together to remove the barriers to make it easier for people to interact and engage.
The development of digital solutions has often been weak in thinking about these issues. There’s evidence that the move to digital solutions in healthcare often widens inequalities. A recent paper sets out the role that health literacy could play as a starting point for digital developments.
I read the other day on the Citizen Literacy site that there's some evidence of those with poor core reading and writing skills using highly innovative work arounds to maintain high levels of digital interaction. The workarounds are not specified but I'd be keen to hear them.
The large amount of consumer digital health technologies – everything from Fitbits or glucose monitors – mean that another socio-economic dimension of inequality may be impacted. Those that can afford the devices might be able to actively manage their health conditions better. This is a digital version of the so-called Inverse Care Law which states that those who most need medical care are least likely to receive it; or to think of it from the opposite perspective those with least need of health care tend to use health services more.
An imbalance in favour of digital skills without the ability to truly understand health information also feels deeply problematic. The ability to input a blood glucose level or perform the operations to calculate a dosage to self-manage an ongoing long-term condition without understanding the impact that could result from a minor transcription error feels fraught with danger.
Our approach to service design is a strong tool to ensure we build technology that is both kind and meets the needs of the people who will use it. In some senses, health and digital literacies are more things for our service design work to consider.
NDS can also become more health literacy responsive as a team. We’re starting to set this thinking in the context of wider equalities activity. This covers everything from making products that meet accessibility standards to how we continue to promote diversity in our recruitment practices.
I have the opportunity to explore the full range of these issues through involvement with a World Health Organization expert group, throughout 2020. While that work will have specific tasks to deliver, it will provide an excellent forum for developing a sharper understanding about how we take effective action on digital and health literacy.
When we know so many people are struggling with the conversation at the heart of health and social care – the interaction between people and their practitioners – we must make sure that digital solutions bridge not widen that gap in understanding. This is fundamental to delivering a set of NDS products that are fair, equitable and responsive to health literacy needs.