A lack of awareness of available health services and how to find and use them is a major challenge which affects the ability of people to find the health care they need. 

Healthcare provision, systems and environments have become increasing complex which can make it challenging for individuals to access services. There is a responsibility to organise these services so that they provide coherent pathways and options for care which people can understand, access and navigate. 

Health literacy research and practice indicates the need to engage mediators as well as community and patient advocates to foster information and communication between hard-to-reach individuals and groups. 

Context

As a precondition, health services should be easily accessible and available to citizens. The ability to find the appropriate primary care serves as an important gateway to the health care system, especially when this concerns interventions regarding severe diseases. Seeking and accessing appropriate care is a matter of responsible behaviour towards others, especially in managing the spread of and in treating communicable diseases. 

Access to appropriate care is a central factor in health disparities and health outcomes. In determining what is appropriate care depends on the consideration of a number of factors: 1) care is based on clear evidence of effectiveness to improve health, and is delivered by health system professionals with the expertise to work in a culturally sensitive manner; 2) care takes into account the use of resources according to the needs of regions and population groups, mindful of the principle of cost-effectiveness; 3) care is offered in a way that secures equity in care delivery; 4) care is patient-centred and therefore sensitive to the context, culture, autonomy, needs and preferences of patients, which includes their involvement in care and empowerment in seeking care and self-management. 

Challenge

A key component in accessing appropriate care is the awareness of one’s rights as a patient. This includes knowing about the existence of health services and how to use them. Not knowing about them may hinder timely access to care. In this regard, those with limited health literacy are more likely to experience difficulties, resulting in delays in receiving care.

Limited health literacy is also linked with the unnecessary and improper use of health services and resources. This is a significant problem in Europe as one in six people report having difficulties in finding out where to get professional help when they are ill . 

Health literacy should not be assumed, especially not among those having special needs or who are otherwise limited in their ability to find and receive care, to navigate the health system environment. For example, people with long-term mental health conditions, older persons, and those with socioeconomic deprivation are more likely to miss appointments. This is of particular concern when they relate to healthcare and disease prevention measures, such as screening and monitoring of chronic disease. 

Ensuring individual access to appropriate care for all parts of the population can be a challenge for health systems, especially when they are complex and fragmented. Consider, for example, the challenges of providing care to migrants with language and communication barriers. It should however be noted that the health literacy of migrants varies in different European countries; in some countries, such as Austria, some migrants are reported as having high levels of health literacy, whereas in others, such as Denmark, it is the opposite. In this regard, cultural mediators as well as knowledge-brokers might be considered in order to “translate” between health system actors and patients.

Actions

Improving individuals’ health literacy means finding the health care one needs and adopting responsible ‘help-seeking’ behaviour. Health systems have a responsibility to develop appropriate care which is made easily available.  

Individuals need:

Systems have a responsibility to:
  • information about one’s rights as patients, including available and options for health care, and be able to demand appropriate care;
  • relevant information about one’s health condition;
  • to be able to identify and interpret the symptoms of various diseases;
  • to know when and where to seek help;
  • to be able to think through the consequences of one’s actions on others (e.g., how to seek health care in relation to communicable diseases).
  • promote cultural sensitivity and understanding of care, to use intercultural mediators if needed to adapt health services to the cultural characteristics of migrants and others in similar situations, offering options for various types of care;
  • make available easy access information on various options for care, in all relevant languages;
  • develop coherent and simple health system environments for people to navigate;
  • involve people in developing user- and health literacy friendly systems.

 

Good practice

Facilitating Syrian refugee access to medical services – Türkiye

Türkiye hosts millions of refugees whose access to health care is hindered by cultural and linguistic barriers. Reinforcing the trust of migrants in health systems and health professionals is a key component in facilitating their access to health systems. 

 Aim and objectives:

The objective of the joint Türkiye, EU and WHO initiative is to familiarise Syrian refugees with the Turkish health care system so that they may practice medicine in Türkiye and provide health services directly to Syrian refugees. In doing so, the initiative fosters the integration of Syrian refugees in Turkish society and empowers them to serve the community. The initiative also helps to alleviate the burden on the Turkish health system. 

 Target group:

The initiative targets Syrian health care workers who form part of the 3.7 million Syrian migrants displaced in Türkiye. In particular, the initiative is designed for doctors, nurses, midwives and other medical specialists. 

 Method:

Syrian health care workers are identified and undergo theoretical and practical training in one of the seven training centres established across the country (Ankara, Gazantiep, Sanliurfa, Izmir and Mersin), under the supervision of Turkish medical professionals.  There, they undertake an adaptation course designed by the WHO country office in Türkiye. During the Covid-19 pandemic, training was dispensed digitally through a specifically developed distance learning platform. The course contents include modules on mental health, non-communicable diseases, early childhood development, psychosocial support training in disasters, medical record systems, and occupational health and safety. The centres also train translators to serve as cultural mediators in medical facilities. Eventually, Syrian health professionals receive authorisation to work in the Turkish health system. 

 Outcomes:

Thousands of health professionals have undergone the program since it began. Teaching materials have been developed as part of the program that have also been used to train Turkish professionals on mental health. 

 Added value:

The employment of Syrian health professionals in Türkiye is instrumental in suppressing language and cultural barriers in access to health care. Their empowerment and integration in Türkiye provide an occupational opportunity for refugees and a chance to gain additional knowledge. This improved the cultural sensitivity of the health system and has helped to build resilience at the local level. More generally, it has improved the health literacy of Syrian refugees. 

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Literacy Audit for Healthcare Settings – Ireland

 Aim and objectives:

This audit, prepared by the National Adult Literacy Agency, seeks to make the Irish health service literacy friendly where both the skills of individuals and the literacy demands of the health service are analysed. It envisions a health service where literacy is not a barrier to treatment. It works to support the health service in every context: promotion, protection, prevention, access to care and maintenance.

 Target group:

The responsibility for making health activities less burdensome and services more accessible rests with those providing the services. Organisations have a responsibility to make their environment easy to access and navigate. While literacy skills are often viewed as the responsibility of the individual, it is important to examine the skills of health professionals as well.

 Method:

The health literacy audit promotes an understanding of how literacy friendly a health setting is. This audit helps to identify possible barriers for adults with literacy difficulties. Healthcare workers need a way to measure how literacy friendly their writing material, websites and general communication are to the public. The audit is designed to help analyse and record how patients and service users might encounter difficulties in accessing health services and in understanding health and administrative messages, and pinpoint areas that can be improved.

 Outcome:

Each organisation can devise its own specific literacy plan based on the results of the audit. The summary sheet is helpful as a record of what work is needed. 

 Added value:

The audit tool helps to inform and qualify the work of health service organisations to become health literacy friendly. The approach can be tailored to suit local needs.

 Literacy Audit for Healthcare Settings - Ireland

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MILSA: A Support Platform for Migration and Health – Sweden

 Aim and objectives:

Receiving information about the society in which you are living in and gaining knowledge of how to take care of your health is a key component for successful integration in society. This is the guiding principle for civic and health communicators working all over Sweden.

MILSA is a knowledge-based support platform for migration and health which is devoted to producing and supporting methodological development conducive to a health-promoting and inclusive reception of newly arrived migrants in Swedish society. 

The MILSA educational platform is a national initiative for civic and health communicators with a focus on education, exchange of experiences and networking. The project is supported by the European Social Fund and the Ministry of Health and Social Affairs of Sweden. The project collaborates with universities and experts in various fields, county administrative boards, regions, municipalities, and civil society organisations at both national and international levels.

The research within MILSA is oriented towards the integration system and needs of newly arrived migrants, and it is carried out by way of broad collaboration between different universities and multi-level agencies that work with newly arrived migrants. The work is based on a broad approach to health, including themes such as societal participation and empowerment, mental health and well-being, housing issues, economic stress, confidence, and trust. 

 Target group:

Approximately 200 communicators provide civic orientation and health communication in different languages throughout the country. MILSA’s educational programme covers 22 essential topics concerning different aspects of life and takes approximately 18 months to complete.

Teachers from several universities, together with experts, have been responsible for shaping the content of the education which is carried out mostly at a distance, supplemented with practical training sessions and physical meetings.

 Method:

In addition to providing a unified education for civic and health communicators, MILSA is producing textbooks on civic and health communication and a manual of methods for communicators. The textbooks are based on the national civic orientation regulation and aim at providing a deeper understanding of the subject areas. The manual of methods is to provide practical hands-on support for the communicators in the classrooms. For example, it deals with how to create a safe environment in the classroom, how to ensure that the participants receive and understand the information that is communicated, how to approach and discuss sensitive topics and what are the limitations of the communicator´s role.

 Outcome:

The MILSA educational platform creates a framework for networking, collaboration and exchange of experiences between communicators and other professionals working on migration, health and integration.

 Added value:

The work in the MILSA educational platform is built on civic orientation of unique potential for newly arrived migrants and opportunities for integration, employment and health.

 MILSA | Partnerskap Skåne (partnerskapskane.se)

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Health care professionals working in nursing homes – Italy

 Aim and objectives:

Health care professionals working in nursing homes, in direct contact with fragile and dependent older persons, are essential for access to appropriate care for those with comorbidities and insufficient family support. Staff working in these settings have specific roles and responsibilities in guaranteeing the best quality of life for these older persons. Measuring the health literacy skills and competencies of these health care professionals is a necessary first step in understanding how and when to build targeted health literacy programs for them.

 Method :

  • by promoting the concept of health literacy in nursing homes;
  • by promoting also specific efforts and programs devoted to the development of the health literacy of health professionals in nursing homes;
  • by involving the directors and personnel of nursing homes in health literacy programs;
  • by developing an ‘organisational health literacy’ approach within nursing homes.

 Outcome:

Nursing homes - via the education of their directors and staff - adopt an ‘organisational health literacy’ approach as a principle of management, aimed at guaranteeing the best access to appropriate care for older persons, especially those who are fragile and dependent.
As a secondary objective, the development of health literacy skills for these health care professionals also helps them at home with their own families.

 Added value:

The health literacy skills and competencies of staff and professionals in nursing homes, in the framework of an ‘organisational health literacy’ approach, supports the right care pathways for older persons in institutionalised settings. This provides health care professionals with an opportunity to apply health literacy skills and competencies in their everyday working lives.

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Tool

Health literacy and patient journeys

 Aim and objectives:

The focus on health literate organisations highlights the need for them to facilitate a coherent and smooth journey for users of the health system. Patient journey mapping (see example below) is a way to visualise and obtain an overview of patient experience during their entire care journey. 

 Method:

A patient journey map (also known as health system customer journey map) is an outline of all the touchpoints a patient goes through in their care journey in a health system facility. This includes all the touchpoints pre-, during, and post-visit. 

 Outcome:

This method provides insights into patient experiences during their care journey in a health system facility and the patient flow in general to create strategies to improve the quality of care, increase efficiency, and improve patient satisfaction.

 Added value:

Patient journey mapping is an increasingly valuable tool for health organisations and companies of all types and sizes, for many applications. The benefits include highlighting the obstacles patients face in accessing care; define how to deliver a better patient experience during treatment; and identify ways to support patients after treatment ends.

 

Figure: Example of health system customer journey map

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