New findings on health literacy
Strengthening health literacy could work better and more easily in Germany. How? Publications from the “Chronic Conditions and Health Literacy” (ChEG) PhD program supported by the Bosch Health Campus shows how.
In their scientific papers, the scholarship holders examine the topic of health literacy from different perspectives and research directions.
Nadine Fischbock had a goosebump moment during her observations of nursing staff for her doctoral thesis. It was a “terribly hot summer day”, recalls the qualified nurse from Hanover. She was standing in the corner of a hospital room watching a nurse looking after an elderly patient. She had asked him for another glass of water with the words: “Everyone always says you should drink a lot.” The nurse shook his head in response. “It's different for you. You have heart failure. This means that your heart can no longer pump as much, for example to get the water out of your legs.” There was a brief silence. “Is that why I often can't sleep so well at night?” came from the senior citizen after a while. “Yes, exactly,” explained the nurse. “Then the water presses on your lungs and you find it harder to breathe.” At the time, the patient had been suffering from her chronic illness and the associated symptoms for more than ten years. But no one had ever explained to her that the amount she drank had an impact on her cardiac output and circulation. Until this hot summer day, when a nurse listened to her, found answers and took the time for a long conversation. “A great moment,” recalls Nadine Fischbock, ”because I could see exactly how trust was built and important knowledge was imparted.”
About four years ago, the nursing hostess and registered nurse came up with the idea of doing a doctorate. At the time, she was working as a management consultant at Hannover Medical School. There she learned about the PhD program “Chronic Conditions and Health Literacy” (ChEG), which was funded by the Bosch Health Campus and was being carried out at Hannover Medical School in cooperation with other universities from 2020 to 2024.
A scholarship as “winning the lottery”
Nadine Fischbock applied with her topic “How do nurses understand and make their contribution to promoting health literacy among patients?”. The 44-year-old was accepted into the interdisciplinary program alongside twelve other scholarship holders. “It was like winning the lottery for me,” says the mother of three. On the one hand, the financial support of around 1,200 euros a month helped her. On the other hand, she benefited from the program content such as the subject-related seminars, the methodology workshops, the individual and intensive support and the regular meetings at which all scholarship holders reported on their current status. “That was always a bit exciting. There was good input and feedback, so you knew what was going in the right direction - and where you needed to rework,” says Nadine Fischbock. However, the program was particularly valuable for her because it brought together a group of people from different scientific backgrounds who were working on a common topic and were able to share their thoughts in a protected environment. Everyone benefited from each other, supported each other and advanced their scientific work together.
In the service of health literacy
“The program has been very successful,” says Susanne Melin, team leader at the Robert Bosch Center for Innovative Healthcare. At the Bosch Health Campus, there were various motivations for funding the program: “On the one hand, we wanted to increase the data and knowledge base on health literacy and advance the still young research on this topic in connection with chronic diseases.” This goal was achieved, as was another: to win over young scientists to the topic of health literacy so that they can identify with it and carry it forward into society and their professions as multipliers.
Health literacy refers to the ability and skills of individuals to find, understand, evaluate and apply health-related information. Health literacy has a significant impact on the state of health, well-being and quality of life of chronically ill people in particular. “The question we are addressing at the Bosch Health Campus is therefore: How can this ability be strengthened and promoted in our healthcare system?” says Susanne Melin and emphasizes: ”We have already been able to bring a lot of expertise and networks to this program, from which we can now reap the rewards in the form of insightful doctoral theses.”
Mediation must not be a question of individual attitude
Nadine Fischbock conducted one-to-one observations and ad hoc interviews in various hospitals for her work. After analyzing all the data, she came to the following conclusions: On the one hand, the group of nurses interviewed showed a low level of awareness of what exactly health literacy is. At the same time, they practise the promotion of health literacy in all possible facets in their actions, in their professional and everyday work – but this depends on their individual attitude and mindset and also the time they have available.
This raises the question of which processes and structures on the wards and in the hospitals can support the teaching and strengthening of health literacy regardless of individual attitudes. The instruments listed by the nursing manager include, for example, admission interviews, nursing rounds, bedside care handovers and a comprehensive nursing process from anamnesis to the planning and implementation of nursing measures and evaluation.
“Such nursing elements are known on most wards, but are not used for a variety of reasons. Yet they offer good opportunities to promote health literacy,” explains Nadine Fischbock. If they were firmly anchored in the work and structures on the ward, they would become the norm. “Then strengthening health literacy, which is so important, would become a matter of course and part of the culture.”
Plain language leads to more understanding
The scholarship holders were deliberately selected from various disciplines such as nursing and social sciences, physiotherapy and linguistics, which is why their work shows a spectrum of different perspectives on the topic of health literacy.
The comprehensibility of health information was also examined by scholarship holders. Janina Kröger analyzed medical advice texts for her doctoral thesis and compared the articles in plain language with those in standard language. “Probably the biggest takeaway from my work is the observation that the guides in standard language are often very complex.
“We need more information in plain language because these texts are easier to understand.”
Only then will this information, which is really important for many people, be accessible without a great deal of cognitive effort.” According to Kröger's findings, it would help, for example, if everyone who publishes health information followed the rules of plain language. For example, the use of short sentences and few passive constructions, the avoidance of foreign words and subordinate clauses. “With texts in plain language, it is important to concentrate on the basic information, to structure the texts well and to formulate them as concretely as possible. You always have to think about what can be assumed to be known. And if in doubt, it's better to explain more,” explains Janina Kröger. As a translation scientist, the health-related seminars on the PhD program were particularly useful to her. “Without the program, this input would have been missing and I would probably never have been able to write my thesis in such an interdisciplinary way.”
Interdisciplinarity is a special feature of the PhD program. “Whatever path the scholarship holders take after their doctorate, we hope that they can have an impact on society in terms of health literacy and its strengthening,” says Susanne Melin - so that health literacy becomes an integral part of all levels of the healthcare system and beyond.