Understanding the oral health literacy of your patients

Have you ever provided oral hygiene instruction to a patient, only to have them return six or 12 months later with little having changed?

While it’s tempting to dismiss their lack of action with thoughts of “they’re just lazy’ or ‘they simply weren’t listening”, there is a real possibility that the patient’s lack of uptake may be reflected by their level of health literacy.

Health literacy is defined as the capacity of individuals to locate and use and comprehend information to improve conditions related to their health as well as their health overall or accessing needed services. In an oral health context, this means:

-    reading, understanding and/or acting on preventive health messages; 
-    Understanding and completing forms, including consent and medical history forms; 
-    the ability to find a dental practitioner and make an appointment; 
-    making informed decisions about their healthcare;
-    navigating the healthcare systems and services and healthcare environment, such as following signs. 

A survey in 2006, by the Australian Bureau of Statistics (ABS) of Adult Literacy and Life Skills reported that 59% of Australians aged 15-74 years did not have the health literacy skills to understand everyday health information, allowing them to effectively access and use health services. For example, some individuals experience difficulty locating the information on a medicine bottle regarding the maximum number of days the medication should be taken. 

In 2014, a study indicated that 57% of Australian adults were unsure of the causes of tooth decay and 58% of Australians believed that cavities happen to everyone. So when you tell a 40-something year-old patient that they have their first cavity, do you consider that it may be something they have never experienced? If people don’t know what causes decay or believe it is inevitable, how are they going to prevent or halt the disease, or even recognise the importance of preventative oral health services and oral hygiene?

Individuals with low level health literacy are reportedly 1.5 - 3 times more likely to experience poor health outcomes. Therefore, it is important as a dental practitioner that you have a good understanding of health literacy, and that each patient should always be considered on an individual basis as a one-size-fits-all explanation/instruction approach does not always work. 

Should dental practitioners have a limited understanding or disregard the concept of health literacy, we may neglect patients’ individual needs. If, as mentioned earlier, your patients return after six to 12 months without any meaningful change in their oral health status, you should consider whether they understood the original information provided.

Take the case of a patient who attends for treatment due to pain. You relieve this pain by performing an emergency extirpation and tell them to return soon to continue treatment; however, they only come back when the pain reoccurs. It’s a choice that likely reflects the patient’s level of health literacy and needs to be addressed because if the patient doesn’t understand the information or the services you are providing, they are at risk of poorer health outcomes.
 
Patients with lower level oral health literacy may be less likely to ask questions, seek clarification or request further information if they do not understand. In these instances, the Australian Commission on Safety and Quality in Health Care regarding recommends you do the following when talking to someone about their oral health:  

-    assume that most patients find it difficult to understand complex health information and adapt your explanations and instructions accordingly;
-    use a range of interpersonal communication strategies to confirm the patient understands the information you have provided;
-    tailor your communication style to suit the needs of each individual patient;
-    encourage patients to speak up if they have difficulty understanding the information provided.

Health literacy is an important concept for both consumers and dental practitioners. As the ADA continues to extend its array of oral health promotional resources, the oral health literacy of consumers will be consistently front of mind in a concerted bid to improve the effectiveness of the oral health messages they contain.