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The Importance of Health Literacy

The Importance of Health Literacy

Since the advent of the Internet, health literacy has risen in the general population. Health literacy is our ability to comprehend health information and to make reasoned choices about our wellbeing.

But with access to more information, there is also the risk of becoming misinformed or overestimating our capacity to interpret both physical and mental health symptoms. Colloquially, we might call one facet of this “Dr Googling.” The phenomenon of limited health knowledge is problematic due to possible inaccuracy and the effects on our self-image and behaviour.

Causes of inaccurate health beliefs

Even well-trained clinicians can misdiagnose despite having all of the facts. A person without training in physical or mental health is going to be much more likely to make errors in explaining health symptoms. Inaccuracies can occur for the following reasons:

Limited understanding of health

On the surface, some health symptoms are easy to interpret. For example, if we have a rash it’s easy to become convinced that it looks the same as one that we found on the Internet and must therefore be due to the same cause. However, a GP would be able to identify slight differences between symptoms and explore a number of causes.

Similarly, it’s easy to read some symptoms and convince yourself that you tick the box. For example, bipolar disorder involves mood swings. You may think, yes, I definitely have mood swings – I must be bipolar. A mental health professional would be more skilled at identifying the severity and quality of these symptoms. Many disorders have symptoms that happen to most people but vary along a continuum. So, having the symptom is more than just having felt that way right now or in the past; it is experiencing the symptom to a certain severity and frequency to meet diagnostic criteria.

Health workers are also able to think in a more systematic and broader way, which is necessary when disentangling health symptoms. For example, if you have trouble concentrating you might Dr Google and be convinced you have ADHD. A health professional would likely think of various different causes and investigate these strategically. For example, trouble concentrating could be caused by depression, poor health (lack of sleep, iron deficiency, an underlying medical condition), or stress and situational factors. Health professionals train for years to develop the knowledge and process of thinking required to diagnose and treat people.

This is not to say that only professionals have knowledge about health. Everyone should strive to improve their knowledge about health and the Australian Commission on Safety and Quality in Health Care provides a number of suggestions about how to improve your health literacy. It’s important to note that these suggestions are about finding reputable sources of information and not diagnosing yourself. Reputable sources might include the health professionals themselves (asking them questions), or legitimate sources such as government websites or handouts. Aside from limited understanding of health, another cause of inaccuracy in self-diagnosis is our emotions.

Emotions get in the way

If something is happening in our body or mind, then who better to figure out the cause than our self? By intuition this idea may appear to be true, but in practice it is more complex. When health students are taught content, they are regularly warned to avoid self-diagnosing or diagnosing those close to them. Once we start thinking about health issues it’s easy to panic, which can impair logical thinking. Another reason to avoid taking diagnosis into your own hands is because symptoms are

often on a continuum, which means we can over-interpret them. Additionally, we can’t really be objective with our own or loved-ones’ health. We already have our view of our self or close other and can practise confirmation bias, in which we only seek out information that will converge on the decision we have already made. Once we are seeing a situation through a certain lens, we start filtering information into relevant and irrelevant. This siphoning of information not only results in circular thinking, but can also prevent proper treatment.

We interfere with our health treatment

If you are convinced you know the cause of your health symptoms, then you may dismiss some information, or may describe details in such a way that it makes it difficult for the health provider to consider other options. For example, it is common for people to describe themselves or others as ‘on the spectrum’ or ‘a bit OCD’ without fully comprehending the meaning of these conditions. This presents a communication barrier between the consumer and health care provider, as they have different understanding of certain terms. Being ‘on the spectrum’ is more than having some social difficulties, just as being OCD cannot be defined as simply liking things to be neat. Using clinical language without a full understanding of the terms means issues may be misinterpreted or missed, or you will have to spend extra time with your clinician figuring out a shared language. It is easier to use simple language to describe your experiences – for example, ‘Sometimes I don’t know what to say in conversations,’ or, ‘I find myself preoccupied with things being neat.’

Sometimes our belief that we understand our health can be so strong that we actually avoid seeking healthcare altogether, even though it is needed (e.g., thinking that not enjoying life is ‘normal’, thus impairing treatment of actual depression). The Internet can contribute to under-treatment, through people reading damaging views about health, such as pro-anorexia sites that strive to glamourise a serious threat to health. Thus, our knowledge of health can also impact our self-image and behaviour.

Effects of health knowledge on self-image and behaviour

Having incorrect views on health may not only impede access to appropriate health care, but might also produce issues with identity and behaviour.

Effects of health beliefs on identity

Seeking information about health from inappropriate sources can lead individuals to take on a sick role. This can happen if you give yourself diagnoses, or if you over-identify with a diagnosis you have been given. For example, if you think you are depressed you might start thinking of yourself as a ‘depressed person,’ reflect on how bad it is to have depression, and ruminate on being ‘ill.’ People are not solely their health issues, and if you see a clinician they should help you to see yourself as a person first (i.e. a person who has a lived experience of depression, not a depressed person).

Effects of health beliefs on behaviour

If you have poor health literacy you may feel helpless and anxious. This may come from a lack of understanding of your health, or a feeling that you do not know how or where to access help. Anxiety can also arise from seeking excessive information, as is seen in health anxiety. Over help-seeking may occur, where you strive to obtain reassurance about health. Alternatively, if you’re not accessing useful and appropriate information on health you might have the view that your experience is either a bigger or lesser problem than it actually is.

For example, Anne is exercising excessively due to the belief that her thighs are too large. Those close to her repeatedly reassure her that her thighs are not large and she is in the healthy weight range. She accesses health information from fitness sites where other users are also highly dissatisfied with their bodies. This information makes her feel it is normal to have such intense dislike to her body, which stops her from accessing treatment for her body image issues.

On the flipside another example might be:

Ben has been diagnosed with rheumatoid arthritis and is looking at online forums to see what he can expect for his quality of life. He reads about debilitating symptoms and feels so overwhelmed that he tries not to think of the diagnosis (and consequently does not follow advice given on how to minimise the effects of the illness).

In this example, Ben is neglecting to consider that those on forums are not a random group; it is likely that people with more severe symptoms would be most likely to post there for support. Thus, he may be overestimating the effect this condition will have for him personally.

Other concerning behaviour that can arise from poor understanding of health can involve seeking ineffective treatment. Not considering the evidence-base for certain treatments or heavily relying on anecdotal evidence can have serious effects on health. An example of this is some of the erroneous and dangerous ideas about protecting yourself against COVID-19 that were in circulation last year.

Another problematic consequence of misunderstanding health is when people misuse health information or twist it for their own motivations. For example, thinking chronic pain means you should always rest could result in deconditioned muscles, further exacerbating pain. Similarly, someone who has anxiety might claim they should be exempt from tasks due to their mental health, which does not acknowledge that continual avoidance exacerbates anxiety symptoms.

Good ways to avoid these consequences of poor health literacy are to:

  • Stick to reputable sources of information when searching online. One great resource is Health Direct, which is government run and gives information on health.
  • Avoid over-researching health. If you feel overwhelmed talk to a professional to make sense of your health symptoms and the best treatment.
  • Recognise forums or anecdotal information may have use, but may also be selective (those with strong views or experiences), biased, or not appropriate for your situation.
  • Know that there are places on the Internet where information that is damaging to health is propagated. Warn young people about this risk.
  • Ask for advice from health professionals. Ask for rationales for given treatment to help you understand how it works and if it is the best choice for you.

Summary

Understanding health topics and being able to seek appropriate treatment is important for everyone. Behaviours like Dr Googling can lead to inaccurate beliefs about health, and may result in poor treatment. Not understanding health issues can also lead to taking on a sick role identity, or to normalising worrying health symptoms. If we do not have good health literacy, we can end up feeling overwhelmed and anxious. We can also seek inappropriate types of treatment or over or underestimate a health concern. To live a life that is healthy and meaningful we should work to improve our understanding of health and how to access support. Ways to improve health literacy have been explored in this article

Author: Erica South, Psychologist at Young Minds Health and Development Network.
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2019