Commentary by Associate Professor Kay Price, School of Nursing and Midwifery
One of the key findings of the National Statement on Health Literacy released this year was that health information and systems have become so complex and hard to understand that almost 60% of adult Australians may not be able to effectively exercise their choice or voice when it comes to making health-related decisions.
This supports the findings of our own research, at UniSA and with colleagues, and means that for the majority of Australians there may be a disconnect between how they think and how health professionals think.
I have no doubt the onus is on health professionals to ensure they stay relevant – and are seen to be relevant – to consumer needs, but our research suggests many health professionals have difficulty in changing their approach.
An important first step is to understand and accept that modern consumers make many choices in relation to their health.
They make choices about whether to visit a health professional, when to visit, and what to say if they do. They then make choices about whether or not to follow what their doctor or other health professional advises them to do to reduce the effects of their illness or to make adjustments to the pace of their daily life. And they make choices about if, when and how to experiment with health strategies and with prescribed, over the counter, complementary alterative medicines.
The reality is that today’s consumer is an object of competition and health professionals are not the only practitioners vying for their attention. The ramifications of these understandings bring health professionals to a place we have not been before.
From our research with consumers we have learnt that care outcomes that matter to an individual living with a chronic disease are not the same as the health outcomes that matter to health professionals and policy makers. Therefore outcomes of care that matter to an individual are more focussed on their “here and now” or “real time” issues rather than in terms of physiological measurements to be achieved and maintained.
An individual with a chronic disease does not always have their chronic condition fore-grounded in their thinking. This is not necessarily related to a lack of understanding of their chronic disease; rather it is as a consequence of them living life with their chronic disease.
To increase the understanding an individual has about their chronic disease requires health professionals to know when to shift the focus away from the chronic disease to the specific life context in which people live. Our findings suggest that when the focus by health professionals is only on the self-management of the chronic disease(s) and not on the person in the context in which they live every day, then people with chronic diseases, for a variety of reasons, may not “self-manage” as instructed by health professionals.
To influence how people make choices that will influence health outcomes, health professionals need to know how to accommodate, in their practice approach, the understanding that people living with chronic conditions do make their own decisions about their health. Information used to inform these decisions made by people living with chronic conditions will be different to the information a health professional may utilise. Consumers understand that physiological measurements alone for measuring health outcomes do not adequately capture their health status.
If a disconnect exists between health outcomes deemed achievable by health professionals in relation to a specific chronic disease with the outcomes the person considers possible, then their ability to manage their chronic disease will not be influenced by what health professionals say to them. We know that people use the internet and health information obtained from the television and friends and consider this is enough to feel they have the capabilities needed to self-manage their health and medicines usage in particular.
Health professionals need to identify new ways to connect with and keep connected to different groups of people who question the rationale for themselves to keep connected with health professionals as traditionally expected. We already know that there are different groups who will not visit, or delay their visit to a general practitioner for example. There is also a risk that health professionals when talking with consumers will talk past them and vice versa, but the greater possibility is that consumers will not access the services health professionals offer.