Health Literacy: Informed choice

Employees’ knowledge about their own and their family’s health remains inadequate to help them decide on the best action to stay well and recover optimally from illness.

In a recent ICM survey,1 two-thirds of employees agreed that if they had more information from their employer about managing common conditions like headaches and indigestion they would take less time off work. This article describes how DPP (Developing Patient Partnerships), a charity with an extensive track record within the NHS, is now developing health information campaigns for other employers and responding to employees’ expressed wish to know more about health issues.

Value of health literacy

DPP is a registered charity, which was established in 1997 through funding from the Department of Health (DoH), and since then has produced more than 100 health promotion and education campaigns in the NHS.

Many of the early campaigns were motivated by demand management, including how to reduce patient demand on NHS services, such as general practice and accident and emergency, through the greater use of pharmacists and improved personal health literacy.

In 2004, the trustees decided that DPP could improve its effectiveness if it went outside the NHS to target key audiences through their workplaces. It focused on those employees known to be hard to reach by the NHS such as male manual workers.

Over the last 15 months, DPP has worked closely with employers such as the motor industry, police and ambulance services, and local authorities, to understand what the benefits of workplace health information might be, and how best to market these benefits.

DPP recognises that while initial interest might come from OH departments, funding will probably come from a number of business units who require a strong business case to justify their investment. With this in mind, DPP’s case for the value of improved health literacy must reach beyond occupational health.2

DPP has concluded that health literacy can help employers achieve three strategic objectives:



  • Improve business performance and reputation
  • Free up OH specialist time
  • Improve individuals’ decision-making capabilities

First, the evidence demonstrates that many of the gains of workplace health promotion cannot be counted in pure health terms.3 Instead, they accrue to the company’s productivity, and to its reputation as a socially responsible employer, responding to employees’ interest in their and their families’ health.4,5 This is not just a cynical marketing exercise, it is an important attitude given the changing demographic profile of the workforce. As the workforce profile ages and the pool of future recruits declines, so companies need to protect their existing staff, particularly from chronic illnesses that may be prevented through lifestyle advice and behaviour change.

Second, OH departments have to spread themselves thinly across their roles of health promotion; screening and assessment; employee support and rehabilitation; analysis and improvement of the environment.

DPP aims to free-up OH staff time, enabling them to deliver services rather than create health information materials. However, it is important that the OH departments stay in control of the health promotion messages of the organisation and that the materials support their behaviour change work.

Therefore, DPP clients can select from a menu of campaigns rather than just disconnected pieces of information and can also commission joiners’ health toolkits that include guidance on how to use OH departments, and other useful local resources, such as the NHS stop smoking support. Whereas DPP’s NHS clients tend to opt for eight campaigns a year, the response from OH teams has been that two to four campaigns is more realistic, with a drip-feed of additional information in between to keep the messages fresh.

Finally, DPP creates material that encourages personal responsibility. The materials are written for a lay audience and are field-tested. For example, a DIY cholesterol control campaign was field-tested at Peugeot-Citron.

The aim is to improve employees’ health literacy by giving them information about the specific health problem, signposting them to appropriate services and encouraging the use of questioning health professionals. The materials recognise the family context and the potential secondary gains of employees sharing information with their families.

The DPP model

DPP believes that information can support change in health literacy at five levels



  • It can impact on an employee’s environment by providing them with facts about health and safety.
  • It can inform people of healthy behaviours, such as what to eat or how to look after your back
  • It can offer alternative mental models, for example, how to manage certain illnesses without a health professional, which may require information about risk
  • It can work at the level of health beliefs, which may require an element of myth breaking, for example, about the impact of work on mental well-being
  • It can support change about an employee’s identity by using stories, role models and survey findings to suggest that it is possible to be a well/fit/mobile person rather than an unhealthy/unfit/sedentary one.

Criteria for excellent health information

DPP has eight criteria for selecting a provider of health information. They should produce information that is:



  • Evidence-based and up-to-date. Are organisations still using old Flora literature? Are they still up-to-date? DPP works with expert partners to produce information based on the latest evidence.
  • From a trusted source.6 The power of the campaign is increased significantly if the source is regarded as credible. DPP’s clients can choose whether to use DPP or their own branding on the materials. They tend to prefer to use DPP’s, or a combination of the two.
  • Practical. The advice has to be feasible for working people across the country. DPP also offers a translation service.
  • Relevant. DPP knows the major causes of workplace sickness and absence nationally and from US studies,7,8 and many OH departments can provide detailed breakdowns of the top five reasons for short and long-term absence. The employee information should focus on these. Therefore, one of DPP’s key campaigns is managing minor illness.
  • In lay language.9 DPP field-tests its material to ensure the target audiences understand it. It also commissions national surveys to provide a ‘hook’ to gain national, lay media interest. It now gains good exposure on national television, in red tops and broadsheets. For example, when DPP launched its complementary medicines campaign, it found 51% of those polled were unaware of the dangers of mixing natural remedies with other medicines, and nearly a quarter (24%) were reluctant to tell their GP about any complementary medicine they were using. DPP’s Working Lunches report, part of the DIY Cholesterol Control campaign, received massive coverage about the finding that skipping lunch and snacking on high fat snacks is fuelling rising cholesterol levels. GMTV invited DPP’s GP spokesman to test the presenters’ cholesterol levels.
  • Capable of customisation. DPP recognises that OH departments may want to include information about local support services. Therefore, it is looking at ways of keeping the cost of materials down by reducing the number of print runs, but still enabling local information to be added. In addition to printed posters and leaflets, DPP provides draft press releases for local customisation. It aims to give the campaign ‘legs’ by offering organisations bite-sized chunks of additional information that they can incorporate into internal newsletters, briefings and email alerts or even add to pay-slips.
  • Available consistently and at different levels of detail. Many OH staff have a favourite leaflet that is no longer available; DPP aims to overcome this problem with a large stock of materials and a comprehensive back catalogue. It also produces a professional’s guide to some of its materials.
  • Signposts reader to seek help. DPP materials can only ever be part of a package. It is important they signpost the reader to seek help. One of DPP’s campaigns was just about this. ‘Pop Down Your Local’ built on DPP research which showed that 24% of men rely on their mums for health advice. DPPs aimed to encourage them to think of their pharmacist as an alternative, and probably more reliable, source of health information.

Better health at home and at work: case study

In January 2005, DPP launched a 32-page self-care guide to minor illness, giving people the information to manage illnesses such as coughs and colds and stress themselves; including what over-the-counter medicines to stock at home. DPP gained significant media exposure through the results of a survey of 1,116 adults in full-time employment showing:



  • If they had more information from their employer about managing common conditions like headaches and indigestion, 71% would visit their GP less
  • 45% would like to receive information directly from their employer about common conditions
  • 95% agreed that having regular work is good for your mental and physical health.

These results were endorsed by Susan Robson, the chairwoman of the BMA’s Occupational Health Committee.10

It is a core element of the package of materials DPP will provide to its corporate clients as it addresses their concerns, confirmed by the 2004 Chartered Institute of Personnel and Development (CIPD) survey that one of the main reasons for short-term absence is employees with minor illness.7

Conclusion

Good quality health information is the platform for all other OH interventions. Its impact can stretch beyond occupational health to the core business of an organisation, as long as it is taken seriously and done by experts.11

DPP will continue to evaluate the impact of its work, using a range of measures wider than just employee health.
References



1. ICM survey (18 January 2005) www.icmresearch.co.uk
2. Potter L, Martin C. What is health literacy? Health literacy fact sheet 1.
http://www.chcs.org/publications3960/publications_show.htm?doc_id=213119 accessed March 2005
3. De Greef, M Van den Broek, K. (2004) ‘Healthy Employees in Healthy Organisations. Making the Case for Workplace Health Promotion’. Prevent, NCO Belgium. May 2004
4. Potter, L,Martin C (2003). Impact of Low Health Literacy Skills on Annual Health Care Expenditures. Center for Health Care Strategies http://www.chcs.org/publications3960/publications_show.htm?doc_id=213128 accessed March 2005
5. Goetzel RZ (2001) A corporate perspective: reflections from the economic buyer of health promotion programs. Am J Health Promot 2001;15(5):357 and subsequent 10 case studies of Fortune 500 companies: GSK, Ford Motor Co, Lucent Technology, Dow Chemicals, Johnson & Johnson, Chevron Corporation, Southern California Edison, 3M, Applied Materials Inc, Hoffman-La Roche Inc. Am J Health Promot 2001;15(5):358-377
6. Dickinson D, and Raynor T D K. (2003) Ask the patients – they may want to know more than you think. British Medical Journal, Oct 2003
7. Employee absence 2004. (2004) A survey of management policy and practice. CIPD July 2004
8. Goetzel RZ et al. (1998) The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database. The Health Enhancement Research Organization (HERO) Research Committee. J. Occup. Environ. Med. 1998;40:843-54
9. Sihota S and Lennard L. (2004) Health literacy: being able to make the most of health. (2004) National Consumer Council. August 2004.
10. http://www.dpp.org.uk/introducing.asp?subsection=newsletter&newslet=news0022 accessed March 2005
11. Garlick W. (2003) Patient information. What’s the prognosis? Consumers’ Association Policy Report. 2003


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