Health Literacy and Health Promotion among Elderly COPD Patients - Literature review Example

Health Literacy and Health Promotion through Empowerment Approach Scenario A group of elderly patients suffering from chronic obstructive pulmonary diseases (COPD) have been experiencing several challenges when it comes the management of their condition. Firstly, these patients come from low socio-economic backgrounds thus they do not have adequate resources to either hire a private nurse or procure necessary medical equipments that will enable them to manage their condition effectively. Secondly, a number of these patients lack adequate family support. Some of them have some level of family support whereas others do not. Consequently, most of these patients do not go out much. They often stay at home because they get tired quickly and are highly dependent on their oxygen supply. Moreover, the literacy levels of most of these patients is moderate to low literacy levels. A majority have different cultural background and about 50% have very limited understanding of English. Since they receive health services from different practitioners, most of them are confused and do not understand they type of treatments they are getting. As a result, most patients often end up being admitted to hospitals on a regular basis. Introduction Chronic conditions like Chronic Obstructive Pulmonary Disease (COPD) require a high level of specialised care and treatment regime. COPD is a life-threatening condition that can diminish a person’s quality of life and affect one’s overall well-being. Patients suffering from COPD often experience blockage of airways, shortness of breath or abnormal breathing. As a result, they may be unable to engage in simple day to day activities (Calverley, 2008; Sadeghi et al 2013). Calverley (2008) observes that 60% of COPD patients report limitations in day to day activities, 45% are often unable to work whereas 75% complain that they experience difficulties in climbing stairs. Kessleret al, (2006), further observe that due to regularly blockage of airways COPD patients often feel that they are suffocating or dying . As a result, many patients become depressed and withdrawn, this in turn affects their personal relationships (Kessleret al, 2006). Not only does COPD diminish patient’s quality of life but it also puts a strain on health care systems. Population studies show that, 50% of patients hospitalized with COPD are often readmitted on a regular basis. (Calverleyet al,2007; Soler-Catalunaet al., 2005). This in turn affects the utilization of healthcare resources. Furthermore, COPD have a significant impact on mortality and morbidity globally (Cazzola et al; Nici et al 2006). Although COPD is life-threatening and can diminish a person’s quality of life, a considerable number of studies show that, if the condition is managed properly, patients can realise positive health outcomes (Robinson, 2010; Sadeghi et al 2013; The Australian Lung Foundation 2012). In essence, when patients take proper care of themselves by maintaining good healthcare habits, taking medications correctly and respond accordingly to COPD exacerbations they can minimize frequent hospital visits, live quality lives and prolong their life-spun (Sadeghi et al 2013). Nevertheless, as depicted in the above scenario, COPD patients especially elderly patients continue to experience poor health outcomes due to challenges such as health illiteracy, poor socio-economic status and lack of support among many other factors. Therefore, in order to improve the health outcomes of elderly COPD patients there is need to empower this population by promoting health literacy and instituting various health promotion initiatives. This paper seeks to examine how a Registered Nurse (RN) working for a private organisation can promote health literacy and health promotion among a population of elderly COPD patients through an empowerment approach. It will explore the role that RNs can play in order to enhance positive behaviour change, manage their condition better, minimize regular hospital admission and improve the quality of their lives. Promoting health literacy Health literacy can be described as the ability or capacity to comprehend and respond to health care information. It is the extent to which individuals have the capacity to access, process and comprehend basic information about health that are required to make sound health decisions (Roberts , Ghiassi & Partridge 2008). Similarly, the World Health Organisation (WHO) defines health literacy as the social and cognitive skills that determine an individual’s motivation and ability to access, understand and utilize information in a manner that promotes positive health outcomes (Chen et al 2013; WHO, 2009). Lee et al (2007) further assert that health literacy entails a person’s cognition to employ preventive care. With regards to COPD, health literacy is characterised by proper communication of health history, self-management, correct administration on medication, timely response to COPD exacerbations adherence to recommendation provided by health care professionals and maintenance of good healthcare habits (Sadeghi et al 2013). Health literacy is one of the key social determinants that significantly influence the health status of individuals. When an individual’s health literacy is inadequate, he or she may be unable to understand the nature of their condition this may in turn affect their self-care ability. Therefore, inadequate health literacy can be detrimental to an individual’s health. For instance, studies conducted by Bourbeau et al (2003), Hill et al (2010) and Sauro et al (2008) established that COPD patients across different outpatient clinics who were educated on self-management made less visits to hospital emergency units and were less frequently hospitalized as compared to patients who have not been educated on self-management. Nevertheless, due to inadequate health literacy and the overuse of complex medical jargon, a number of elderly COPD patients fail to comprehend how to effectively manage their condition. Among the elderly COPD patients, health literacy proves to be a challenge. For instance, data from the National Assessment of Adult Literacy show that only 3% of the elderly population have good health literacy whereas 29% have inadequate health literacy. This shows that there is a serious health literacy deficiency amongst the elderly population. Bennett et al (2012) particularly notes that low literacy is particularly a problem among patients who are 65 years and above. In the provided scenario, it is evident that low health literacy is one the key challenges that the elderly COPD patients have to overcome in order for them to initiate positive health behavioural changes, manage their condition better, minimise hospital admission and improve the quality of their lives. In order for RNs to promote health literacy among this population, they should; develop programs that teach basic reading and writing skills, carryout telephone interventions and develop patient education and support groups. Teaching basic reading and writing skills The lack of basic reading and writing skills among elderly patients can be a major impediment to achieving health literacy. Glenn (2011) observes that patients who have low health literacy often lack basic reading and writing skills. As a result, they are not able to read and understand prescription bottles, educational brochures, appointment slips or COPD self-management instructions. Moreover, they are not able to record their medical history or fill in insurance forms (Bennett, 2012; Glenn, 2011). Therefore, in order for RNs to promote health literacy among elderly COPD patients they can initiate adult learning programs that teach basic and writing skills. These programs will help to equip elderly COPD patients with relevant skills and knowledge on how to read and write. Consequently, they will be able to read and understand information on prescription bottles, educational brochures, appointment slips or COPD self-management instructions. Moreover, they will be able to record their medical histories. Telephone Interventions Telephone interventions can also prove to be effective in promoting health literacy and enabling elderly patients to self-manage their condition. This intervention involves the use of telephone for consultations, monitoring patient progress and disseminating information to patients who may not be able to read and understand COPD self-management instructions. It may also enable RNs to offer personalized care thus addressing language and cultural barriers. In this case, RNs can make telephone calls to patients on a weekly or monthly basis to finding out the progress that the patient in making and offer advice on how patients can improve their health outcomes (Bosworth et al; Sadeghi et al 2013). A study conducted by Bosworth et al (2005) established that telephone interventions enhance patient’s confidence in self-management and adherence to medication. Patient education and support groups Moreover, RNs can initiate community based COPD patient education groups. The focus on these groups should be to provide patients with an avenue where they can learn how to manage their condition, interact with others and share ideas on how to improve their health outcomes. Furthermore, these education and support groups should offer patients moral support to overcome challenges associated with COPD. In addition, the groups should incorporate therapeutic activities such as light sports, games and sight-seeing adventures so as to enable patients to relieve stress associated with their illness. In a study conducted by Robinson (2010), it was established that COPD patients who underwent group based education programs felt empowered and confident that they can self-manage their condition. Health Promotion Besides health literacy, there are various social determinants that influence the health outcomes of COPD patients described in the provided scenario. Some of these determinants include; socio-economic status, culture, family and community support. According to Eisner et al (2011) socio-economic status has significant influence on the health and longevity of patients living with COPD. Socio-economic status impacts on COPD health outcomes in a number of ways. Firstly, it determines the quality of care that a patient receives. Patients from affluent economic backgrounds are more likely to receive quality health care than patients from poor backgrounds. Moreover, patients from affluent backgrounds are more likely to access information easily either through the internet or from their health specialists. On the other hand, patients with low socio-economic status especially those from rural areas may experience barriers such as difficulties in accessing information and long travel distance to healthcare facilities. Additionally, patient from low socio-economic status are more susceptible to familial and community problems associated with poverty. As a result they may lack social support networks that can empower them to effectively manage their problems (Eisner et al 2011). For instance, in the provided scenario, most of the elderly COPD patient lack or have inadequate family support. Therefore, in order for RNs to foster health promotion amongst elderly COPD patients from poor socio-economic backgrounds, they should initiate community development initiatives, develop supportive environments and implement public awareness campaigns on COPD (Department of Health WA, 2012). Community development initiatives In relations to elderly COPD patients, community development initiatives can play a significant role in influencing positive health behaviours particularly those in relation to nutrition, self-management and adherence to medical appointments. Community development initiatives can empower individuals and groups by equipping them with skills they require to effect positive change. In order to promote positive health outcomes amongst elderly patients with COPD, RN’s can initiate community development initiatives by partnering with the local government and community based organisations in developing initiatives such as fitness and therapy sessions (Department of Health WA, 2012). Developing supportive environments RN’s can partner with stakeholders in the community to create health facilities and services in the community that increase better outcomes for elderly COPD patients. For instance, they can introduce out-patient COPD consultation services. Moreover, they can introduce transport services to transport COPD patients to and from their regular hospital appointments (Department of Health WA, 2012). Public awareness campaigns Elderly COPD patients need support not only from their families and caregivers but also from community members. Community members can play a significant role in promoting positive health outcomes amongst COPD patients. For instance, community members can assist elderly COPD patients in accessing health care facilities and taking preventative measures such ceasing to smoke in public. RN’s can initiate public awareness campaigns aimed at educating the community how to prevent COPD by fighting cigarette smoking addiction and the importance of regular medical checkup, proper nutrition and exercising regularly. Through these public awareness campaigns RN’s can disseminate culturally appropriate information that people from different cultural backgrounds can relate to. Conclusion This paper has examined how Registered Nurses (RNs) working for a private organisation can promote health literacy and health promotion among a population of elderly COPD patients through an empowerment approach. The findings of this paper show that although COPD is life-threatening and can diminish a person’s quality of life, if managed properly, patients can realise positive health outcomes (Robinson, 2010; Sadeghi et al 2013; The Australian Lung Foundation 2012). Health literacy is one of the key social determinants that significantly influence the health status of elderly COPD patients. It is recommended in this paper that, in order for RNs to promote health literacy among this population, they should; develop programs that teach basic reading and writing skills, carryout telephone interventions and develop patient education and support groups. Moreover, socio-economic status, culture, family and community support can influence the health outcomes of COPD patients. These factors determine the quality of care that patients receive. Therefore, RN’s can empower and foster health promotion by initiating community development initiatives, developing supportive environments and implementing public awareness campaigns on COPD (Department of Health WA, 2012). References Bennett J, Boyle P, James B & Bennett D (2012). “Correlates of health and financial literacy in older adults with dementia.” BMC Geriatrics 12:2-9 Bosworth HB, Olsen MK, Gentry P, Orr M, Dudley T, McCant F& Oddone EZ.(2005).”Nurse administered telephone intervention for blood pressure control: a patient tailored multifactorial intervention”. Patient Education and Counseling 7:5–14. Bourbeau J, Julien M, Maltais F (2003). “Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention”. Archives of Internal Medicine 163:585–91. Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C & Jones PW.(2007). “Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease”. New England Journal of Medicine 356: 775–789. Calverley, PM. (2008). “COPD: what is the unmet need?” British Journal of Pharmacology 155: 487-493. Cazzola M, MacNee W, Martinez FJ, Rabe KF, Franciosi LG & Barnes PJ (2008). “Outcomes for COPD pharmacological trails: From lung function to biomarkers”. European Respiratory Journal 31:416–468. Chen J, Hsu H, Tung, H. & Pan L (2013).”Effects of health literacy of self-efficacy and preventive care among older adults”. Geriatrics& Gerontology International 13: 70-76. Department of Health Western Australia (2012). Western Australian Health Promotion Strategic Framework 2012–201. Retrieved on May 10, 2013 Eisner MD, Blanc PD, Omachi TA, Yelin EH, Sidney S, Katz P, Ackerson LM, Sanchez G, Tolstykh, I & Iribarren C 2011, “Socioeconomic status, race and COPD health outcomes”. Journal of Epidemiology and Community Health 65: 26-34. Glenn E (2011). “Health literacy is vital and too many lack it”. Philadelphia Tribune. March 29 2011. Hill K, Mangovski-Alzamora S, Blouin M, Guyatt G, Heels-Ansdell D, Bragaglia P, Tamari I, Jones K & Goldstein R. “Disease-specific education in the primary care setting increases the knowledge of people with chronic obstructive pulmonary disease: A randomized controlled trial”. Patient Education Counseling 81(1):14–8. Kessler R, Stahl E, Vogelmeier C, Haughney J, Trudeau E & Lofdahl CG (2006). “Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study”. Chest130: 133–142. Lee LL, Avis M, Arthur A. (2007). “The role of self-efficacy in older people’s decisions to initiate and maintain regular walking as exercise – findings from a qualitative study”. Preventive Medicine 45: 62–65. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J (2006). “American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation”. American Journal respiratory Critical Care Medicine 173: 1390–1413. Nutbeam D (2008). “The evolving concept of health literacy”. Social Science and Medicine 67:2072–8 Roberts N, Ghiassi R & Partridge M 2008, “Health literacy in COPD”, International Journal of COPD 3(4): 499-507. Robinson T (2010). “Empowering people to self manage COPD with management plans and handheld records”. Nursing Times 106(38): 12-14. Sadeghi S, Brooks D, Stagg-Peterson S & Goldstein R (2013). “Growing Awareness of the Importance of Health Literacy in Individuals with COPD”. Journal of Chronic Obstructive Pulmonary Disease 10: 72-78. Sauro A, Greco A, Greco P L, Scalzitti F, Sirignano AR, Sortino D, Letizia M. “The COPD Italian Lung Information Needs Questionnaire (LINQ): Development, preliminary validation, and findings”. European Journal of General Practice 14:65–67. Soler-Cataluna JJ, Martinez-Garcia MA, Roman SP, Salcedo E, Navarro M & Ochando R (2005). “Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease”. Thorax 60: 925–931. The Australian Lung Foundation & Queensland Health (2012). Better Living with Chronic Obstructive Pulmonary Disease: A Patient Guide. 2nd Ed. Retrieved on May 10, 2013 World Health Organization (WHO) (2009). Promotion Health literacy and health behavior. 7th Global Conference on Health. Retrieved on May 10, 2013 Read More