The Perspectives on Barriers and Facilitators in Communication by the Healthcare Professionals and Older Healthcare Users: The Role of Health Literacy

Authors

  • Areti Efthymiou Quality of Life Lab, Social Work Department, Hellenic Mediterranean University, Heraklion, Crete, Greece
  • Michael Rovithis Department of Nursing, Hellenic Mediterranean University, Heraklion, Crete, Greece
  • Argyroula Kalaitzaki Quality of Life Lab, Social Work Department, Hellenic Mediterranean University, Heraklion, Crete, Greece and Affiliated Researcher of the Research Centre ‘Institute of Agri-Food and Life Sciences’, Hellenic Mediterranean University, Heraklion, Crete, Greece

DOI:

https://doi.org/10.12974/2313-1047.2022.09.1

Keywords:

Communication, Health services, Health providers, Qualitative, Older adults (excluding the words in the title)

Abstract

Introduction: Older people are the basic users of health services. However, studies have shown that they have relatively low health literacy (HL) levels which results in many negative health outcomes. HL is a major challenge in public healthcare systems and an important determinant of optimised health outcomes and better quality of life for older people. On the other hand, professionals lack knowledge and skills to identify older people’s HL level and therefore, the delivery of care may be insufficient.

The study aimed to report the perspectives on the barriers and facilitators in communication during the medical encounter by both the healthcare professionals and older healthcare users.

Method: A qualitative study design was applied. One group with seven healthcare professionals and another one with five people over 60 years old discussed about HL knowledge and their experiences (attitudes and behaviors, barriers, and facilitators) of the healthcare professional -patient interaction. The focus groups took place virtually and were coordinated by the senior author. The discussions were analysed using the content analysis method.

Results: Communication facilitators during the healthcare professional-patient interaction as reported by the healthcare professionals included: the need to trust and collaborate with the older people, patients’ specific characteristics (high level of education, psychological resilience and good judgmental), carers’ participation, the use of clear language and a person-centred approach. Communication barriers were considered the older people’s rigid beliefs about their lifestyle, the age-related cognitive, psychological, and sensory deficits, the function, and the structure of the healthcare system (e.g., professionals’ excessive workload). On the other hand, older people mentioned the importance of being prepared to ask questions during the medical encounter, being respected and included in the decision-making process.

Conclusion: Easy-to-use Health Literacy training tools adapted to healthcare professionals’ everyday needs are considered necessary to improve the professionals-patients interaction, enhance their communication skills and promote the person-centred care within the framework of the Greek National Healthcare System. The integration of the tools as part of the training courses could prepare healthcare professionals with the enhanced the HL skills needed to improve the quality of care they provide and reduce the cost of care in general.

References

EUROSTAT. Ageing Europe. Looking at the lives of older people in the EU (2019 edition)

[Internet]. Luxembourg: Publications Office of the European Union; 2019. Available from: https: //ec.europa.eu/eurostat/documents/ 3217494/10166544/KS-02-19 681-EN-N.pdf/c701972f-6b4eb432- 57d2-91898ca94893

Global burden of disease study 2013 collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990 - 2013: a systematic analysis for the Global burden of disease stud. Lancet (London, England). 2015; 386(9995): 743-800.

Kyle S, Shaw D. Doctor-patient communication, patient knowledge and health literacy: How difficult can it all be? Ann E Coll Surg Engl (Suppl). 2014; 96: e9-13. https://doi.org/10.1308/rcsbull.2014.96.6.e9

Sørensen K, van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC public health

[Internet]. 2012; 12(8): 80. https://doi.org/10.1186/1471-2458-12-80

World Health Organization. Health literacy: The solid facts

[Internet]. Denmark: World Health Organisation Regional Office for Europe; 2013. 86. Available from: https: //apps.who.int/iris/bitstream/handle/10665/128703/e96854.pd f

James BD, Boyle PA, Bennett JS, Bennett DA. The impact of health and financial literacy on decision making in community-based older adults. Gerontology. 2012; 58(6): 531-9. https://doi.org/10.1159/000339094

Oliveira D, Bosco A, di Lorito C. Is poor health literacy a risk factor for dementia in older adults? Systematic literature review of prospective cohort studies. Maturitas. 2019; 124: 8- 14. https://doi.org/10.1016/j.maturitas.2019.03.010

Chesser AK, Keene Woods N, Smothers K, Rogers N. Health literacy and older adults. Gerontol Geriatr Med. 2016; 2: 233372141663049. https://doi.org/10.1177/2333721416630492

Zamora H, Clingerman EM. Health literacy among older adults: A systamatic literature review. J Gerontol Nurs. 2011; 37(10): 41-51. https://doi.org/10.3928/00989134-20110503-02

van Ruth Koops TJ, Hoeks JCJ, Jansen CJM, de Winter AF, Reijneveld SA. Comprehensibility of health-related documents for older adults with different levels of health literacy: A systematic review. J Health Commun. 2016; 21: 159-77. https://doi.org/10.1080/10810730.2015.1049306

Mirmohammadkhani M, Ziari A, Momeni M. Systematic review and meta-analysis of health literacy in Iranian older adults. Iranian Journal of Ageing. 2020; 15: 2-13. https://doi.org/10.32598/sija.2020.3.210

Delgado JM, Ruppar TM. Health literacy in older latinos with heart failure: A systematic review. J Cardiovasc Nurs. 2017; 32: 125-34. https://doi.org/10.1097/JCN.0000000000000314

Agarwal G, Habing K, Pirrie M, Angeles R, Marzanek F, Parascandalo J. Assessing health literacy among older adults living in subsidized housing: a cross-sectional study. Can J Public Health. 2018; 109(3): 401-9. https://doi.org/10.17269/s41997-018-0048-3

Liang CY, Wang KY, Hwang SJ, Lin KC, Pan HH. Factors affecting the physician-patient relationship of older veterans with inadequate health literacy: An observational study. Br J Gen Pract. 2013; 63(610). https://doi.org/10.3399/bjgp13X667222

Kondilis BK, Agrafiotis D, Ph D. The European health literacy survey - case of Greece. 2012.

Mayo-Gamble TL, Mouton C. Examining the association between health literacy and medication adherence among older adults. Health Commun. 2018; 33(9): 1124-30. https://doi.org/10.1080/10410236.2017.1331311

Smaje A, Weston-Clark M, Raj R, Orlu M, Davis D, Rawle M. Factors associated with medication adherence in older patients: A systematic review. Aging Med. 2018; 1(3): 254- 66. https://doi.org/10.1002/agm2.12045

Harbishettar V, Krishna K, Srinivasa P, Gowda M. The enigma of doctor-patient relationship. Indian J Psychiatry. 2019; 61(4): S776-81.

Foucault M. The birth of the clinic. Routledge. 2003. https://doi.org/10.4324/9780203406373

Oedekoven M, Herrmann WJ, Ernsting C, Schnitzer S, Kanzler M, Kuhlmey A, et al. Patients' health literacy in relation to the preference for a general practitioner as the source of health information. BMC Fam Pract. 2019; 20(1). https://doi.org/10.1186/s12875-019-0975-y

Lamont RA, Swift HJ, Abrams D. A review and meta-analysis of age-based stereotype threat: Negative stereotypes, not facts, do the damage. Psychology and Aging. 2015; 30(1): 180-93. https://doi.org/10.1037/a0038586

Kim MY, Oh S. Nurses' perspectives on health education and health literacy of older patients. Int J Environ Res and Public Health. 2020; 17(6466). https://doi.org/10.3390/ijerph17186455

Dickens C, Lambert BL, Cromwell T, Piano MR. Nurse overestimation of patients' health literacy. J Health Commun. 2013; 18(SUPPL. 1): 62-9. https://doi.org/10.1080/10810730.2013.825670

Goggins K, Wallston KA, Mion L, Cawthon C, Kripalani S. What patient characteristics influence nurses' assessment of health literacy? J Health Commun. 2016; 21: 105-8. https://doi.org/10.1080/10810730.2016.1193919

Storms H, Aertgeerts B, Vandenabeele F, Claes N. General practitioners' predictions of their own patients' health literacy: A cross-sectional study in Belgium. BMJ Open. 2019; 9(9). https://doi.org/10.1136/bmjopen-2019-029357

Rajah R, Azmi M, Hassali A, Jou LC, Murugiah MK. The perspective of healthcare providers and patients on health literacy: a systematic review of the quantitative and qualitative studies. Perspect Public Health. 2018; 138(2): 122-32. https://doi.org/10.1177/1757913917733775

Chipidza FE, Wallwork RS, Stern TA. Impact of the doctorpatient relationship. Prim Care Companion J Clin Psychiatry. 2015; 17(5): 360. https://doi.org/10.4088/PCC.15f01840

Sadeghi S, Brooks D, Goldstein RS. Patients' and providers' perceptions of the impact of health literacy on communication in pulmonary rehabilitation. Chron Respir Dis. 2013; 10(2): 65-76. https://doi.org/10.1177/1479972312471548

MacAbasco-O'Connell A, Fry-Bowers EK. Knowledge and perceptions of health literacy among nursing professionals. J Health Commun. 2011; 16(SUPPL. 3): 295-307. https://doi.org/10.1080/10810730.2011.604389

O.Nyumba T, Wilson K, Derrick CJ, Mukherjee N. The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods Ecol and Evol. 2018; 9(1): 20-32. https://doi.org/10.1111/2041-210X.12860

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6): 349-57. https://doi.org/10.1093/intqhc/mzm042

Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Vol. 15, Nursing and Health Sciences. 2013. p. 398-405 https://doi.org/10.1111/nhs.12048

Pitt MB, Hendrickson MA. Eradicating jargon-oblivion-A proposed classification system of medical jargon. J Gen Intern Med. 2020; 35(6): 1861-4. https://doi.org/10.1007/s11606-019-05526-1

Koster ES, Philbert D, Blom L, Bouvy ML. "These patients look lost" - Community pharmacy staff's identification and support of patients with limited health literacy. Int J Pharm Pract. 2016; 24(6): 403-10. https://doi.org/10.1111/ijpp.12272

Liu YB, Li YF, Liu L, Chen YL. Effectiveness of the teachback method for improving the health literacy of senior citizens in nursing homes. Jpn J Nurs Sci. 2018; 15(3): 195- 202. https://doi.org/10.1111/jjns.12192

Shersher V, Haines TP, Sturgiss L, Weller C, Williams C. Definitions and use of the teach-back method in healthcare consultations with patients: A systematic review and thematic synthesis. Patient Educ Couns. 2021; 104(1): 118-29. https://doi.org/10.1016/j.pec.2020.07.026

Teófilo TJS, Veras RFS, Silva VA, Cunha NM, Oliveira J dos S, Vasconcelos SC. Empathy in the nurse-patient relationship in geriatric care: An integrative review. Nurs Ethics. 2018; 26(6): 1585-600. https://doi.org/10.1177/0969733018787228

Czypionka T, Kraus M, Reiss M, Baltaxe E, Roca J, Ruths S, et al. The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs. BMC Health Serv Res. 2020; 20(1). https://doi.org/10.1186/s12913-020-05917-9

Manafo E, Wong S. Health literacy programs for older adults: A systematic literature review. Health Educ Res. 2012; 27: 947-60. https://doi.org/10.1093/her/cys067

Slatyer S, Toye C, Burton E, Jacinto AF, Hill KD. Measurement properties of self-report instruments to assess health literacy in older adults: a systematic review. Disability and Rehabilitation. Taylor and Francis Ltd.; 2020. https://doi.org/10.1080/09638288.2020.1836044

Toronto CE, Weatherford B. Health literacy education in health professions schools: An integrative review. J Nurs Educ. 2015; 54(12): 669-76. https://doi.org/10.3928/01484834-20151110-02

IMPACCT Erasmus+. Working with Patients with Limited Health Literacy

[Internet]. Future Learn. 2017

[cited 2021 Feb 20]. Available from: https: //www.futurelearn.com/ courses/working-health-literacy

Kripalani S, Jacobson KL, Brown S, Manning K, Rask KJ, Jacobson TA. Development and implementation of a health literacy training program for medical residents. Med Educ Online. 2006; 11(1): 4612. https://doi.org/10.3402/meo.v11i.4612

Downloads

Published

2022-06-10

How to Cite

Efthymiou, A., Rovithis, M., & Kalaitzaki, A. (2022). The Perspectives on Barriers and Facilitators in Communication by the Healthcare Professionals and Older Healthcare Users: The Role of Health Literacy. Journal of Psychology and Psychotherapy Research, 9, 1–11. https://doi.org/10.12974/2313-1047.2022.09.1

Issue

Section

Articles