Health literacy is basically how much a person is able to find and understand health information or concepts and use the health system. Turns out despite what certain celebrity chefs would have you think, health is a complex topic and not everyone gets it. Someone with a lower level of education, lower socioeconomic status, who lives in less populated areas, or has advanced age can predispose them to having inadequate health literacy (van der Heide et al. 2013; Lee et al. 2010; Howard et al. 2006) which is linked to poorer health outcomes (Bennett et al. 2009; Berkman et al. 2011; Lee et al. 2010; van der Heide et al. 2013). Only 43% of Australians have adequate health literacy (Australian Bureau of Statistics, 2006). Where do you think you sit?
It’s important to note that exercise and understanding the need to exercise is something health literacy affects. For rehabilitation following a hospital stay, if a client does not understand the relevance of the exercise they are prescribed, they will be less likely to continue with their rehabilitation (Norman, 1998). If a client chooses to discontinue their exercises then they are obviously less likely to make a full recovery, but they are also less likely to partake in independent exercise at a level high enough to be beneficial for them (Carlson et al. 2000; Daltroy, 1985). This compliance issue has existed for decades and is still considered to be a major challenge in the rehabilitation and maintenance space of physiotherapy.
It has been shown that for the elderly population, beliefs about exercise and its benefits can be major factors affecting their adherence to an exercise program (Resnick & Spellbring, 2000) and this falls under a health literacy space. To prevent low health literacy from being a factor ruining exercise compliance, the patient needs to improve their knowledge of their condition, learn how best to manage it, and then learn how to manage it themselves (Gold & McClung, 2006). Guiding the patient through that process will teach them what to do to attain their highest possible quality of life but also what to do when they have a bad day and symptoms increase. This also boosts patient self-efficacy, which determines how confident someone feels they are when managing their health. Low self-efficacy has been shown to be a major contributing factor to non-compliance (Chen et al. 1999), but health professionals are in a great position to address this.
You ready for the plug? You could use a Health LEADS approach to improve health literacy and hence exercise compliance. Collaborative goal setting is a way the clinician can negotiate around barriers and beliefs and set targets with the client, giving them a stake in their own treatment prescription, and thus engaging them. These goals must be relevant to the client and it has been shown that when the patient is involved in goal setting, they are more compliant to an exercise program (Bassett & Petrie, 1999), particularly group/team programs (Nielsen et al. 2014). Taking a goal directed approach also improves the patient’s ability to achieve their outcomes, another key element of Health LEADS. Encouraging self-management is another good option for ensuring long-term adherence to healthy behaviours (Lorig et al. 2001; Gold & McClung, 2006). Getting involved in a self-management program (if applicable) presents the client to a group of similar individuals and a peer successfully managing life with the condition which can all be used as proof of achievable outcomes through adherence to the treatment plan. You just have to know what’s out there.
Australian Bureau of Statistics (2006). 4233.0 – Health Literacy, Australia, 2006. Retrieved from: http://abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4233.0Main%20Features22006?opendocument&tabname=Summary&prodno=4233.0&issue=2006&num=&view=
Bassett, S. F., & Petrie, K. J. (1999). The effect of treatment goals on patient compliance with physiotherapy exercise programmes. Physiotherapy, 85(3), 130-137.
Bennett, I. M., Chen, J., Soroui, J. S., & White, S. (2009). The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. The Annals of Family Medicine, 7(3), 204-211.
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: an updated systematic review. Annals of internal medicine, 155(2), 97-107.
Carlson, J. J., Johnson, J. A., Franklin, B. A., & VanderLaan, R. L. (2000). Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation. The American journal of cardiology, 86(1), 17-23.
Chen, C. Y., Neufeld, P. S., Feely, C. A., & Skinner, C. S. (1999). Factors influencing compliance with home exercise programs among patients with upper-extremity impairment. American Journal of Occupational Therapy, 53(2), 171-180.
Daltroy, L. H. (1985). Improving cardiac patient adherence to exercise regimens. Journal of Cardiac Rehabilitation, 5(1), 40.
Howard, D. H., Sentell, T., & Gazmararian, J. A. (2006). Impact of health literacy on socioeconomic and racial differences in health in an elderly population. Journal of general internal medicine, 21(8), 857-861.
Lee, S. Y. D., Tsai, T. I., Tsai, Y. W., & Kuo, K. N. (2010). Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC public health, 10(1), 614.
Lorig, K. R., Sobel, D. S., Ritter, P. L., Laurent, D., & Hobbs, M. (2000). Effect of a self-management program on patients with chronic disease. Effective clinical practice: ECP, 4(6), 256-262.
Nielsen, G., Wikman, J. M., Jensen, C. J., Schmidt, J. F., Gliemann, L., & Andersen, T. R. (2014). Health promotion: The impact of beliefs of health benefits, social relations and enjoyment on exercise continuation. Scandinavian journal of medicine & science in sports, 24(S1), 66-75.
Norman, K. V. (1998). Motivation and compliance in exercise programs for older adults. Journal of Physical Education, Recreation & Dance, 69(8), 24-27.
Resnick, B., & Spellbring, A. M. (2000). Understanding what motivates older adults to exercise. Journal of gerontological nursing, 26(3), 34-42.
van der Heide, I., Wang, J., Droomers, M., Spreeuwenberg, P., Rademakers, J., & Uiters, E. (2013). The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey. Journal of health communication, 18(sup1), 172-184.