Innovations in Whole Person Care: Health Literacy Across the Lifespan

Jessamin E. Cipollina, M.A.

The American Academy of Pediatric Dentistry (AAPD) recommends that children have a dental home by their first birthday to prevent negative oral health outcomes.1 However, according to a recent report from the AAPD, a whopping 74% of American parents do not take their child to the dentist until much later.1 They report that 29% of the remaining 26% of parents who do take their child before age 1 are more likely to be from the millennial generation than any other generation of parents.1 This reflects further data about general oral health knowledge and literacy in the U.S.

The AAPD reports that while almost 100% of parents say oral health is an important in their household, 31% of them feel stomach aches, earaches headaches and sore throats are more concerning ailments than toothaches.1 Poor oral health connects to all sorts of general health issues, including diabetes, cancer, heart problems, among others. As we moved into the new millennium almost 20 years ago, scientists and researchers made various predictions about the future of health literacy and communication. Many concerns focused on internet access and new information technology. Now, in 2018, we have an opportunity to reflect on how health information is disseminated to various populations, and how health professionals and researchers can best address the remaining gaps in health literacy and knowledge.

Research from the early 2000s reveals concerns and goals for moving forward with improving health literacy. Reports showed that efforts to advance health literacy are consistently grounded in the relationships among education levels and overall population literacy and health status in the U.S., U.K. and beyond.2 Limited access to education is also often related to poor social development and health outcomes; areas with high literacy and education have significantly better outcomes in these areas.2

Early publications supporting the need for improved health literacy cite policy issues with consistently defining “health literacy” as a barrier.3 Policies to improve education and policies to improve health literacy were seldom linked. This intersection needed to be addressed to best understand how to improve low health literacy and provide accessible health and healthcare knowledge.2,3

Components of health literacy education include reading and comprehension skills as well as utilizing technology and being discerning consumers of online information.3 Researchers also identified an “inverse relationship between increasing age and health literacy” which is problematic as older adults are more likely to have chronic health conditions that increase the risk for poor oral health that is often overlooked.3 Poor oral health is linked to a variety of other health complications at any age, which is why interprofessional practice and care, including oral health competencies and patient education, is so important. These predictions from almost twenty years ago are still very relevant today.

Current research on oral health literacy demonstrates the need to address issues that lie at the intersection of oral health, overall health, education and policy. One way to close health and education gaps is by providing and promoting oral health education that is accurate, easy to understand and, ideally, free. A health literacy partnership between the Oral Health Nursing Education and Practice (OHNEP) program and the American College of Physicians (ACP) developed evidence-based Oral Health Fact sheets for use in primary care settings. Written at the 6th grade reading level, these handouts provide an overview of common oral health problems and key treatment and practices for good oral health. These handouts describe the common oral health problems linked with diabetes, HPV and aging. You can find them in both English and Spanish here. These resources are an example of health literacy products to increase informative and easily accessible oral health knowledge and self-care that can be distributed to patients by MDs, NPs, RNs, and PAs at patient visits or online through patient portals.

Nurse practitioners, pediatric care practitioners, midwives, physicians and physicians assistants are among non-dental health care practitioners that should be able to screen for and identify oral health issues across the lifespan and make recommendations and referrals.4,5 Along with improving oral health literacy among patients, interprofessional education should become a standard in health professions curricula.4,5 Curricula that have multiple interprofessional experiences that weave oral health into course content as well as simulation and “live” clinical experiences, allow future professionals to be better informed about the connections between oral health and overall health.5

Primary care providers should be able to provide basic information and education to individuals affected by oral-systemic health issues to further promote widespread literacy. 4,5 Recent literature in this area suggests that to make significant change in oral health literacy, all health professions need to incorporate oral health in their histories and physical exams, risk assessments, and management plans including dental referrals. 4,5 Despite growing oral health efforts in advocacy and education through programs such as OHNEP, it remains challenging to find and to implement integrated medical-dental practices.5 The past 20 years have brought on new challenges in oral health and overall health literacy; health professions should be taking advantage of new technologies and research findings to change and advance health literacy policy, education and practice.

References

  1. New survey by america’s pediatric dentists highlights gaps in oral health knowledge and generational differences in caring for little teeth [press release]. Chicago, IL: Markets Insider; October 3, 2018. https://markets.businessinsider.com/news/stocks/new-survey-by-america-s-pediatric-dentists-highlights-gaps-in-oral-health-knowledge-and-generational-differences-in-caring-for-little-teeth-1027586677
  2. Nutbeam, D., Kickbusch, I. Advancing health literacy: A global challenge for the 21st century. Int J Ment Health Promot. 2000; 13(3):183-184. doi: 10.1093/heapro/15.3.183
  3. Parker, R., Ratzan, S., Lurie N. Health literacy: A policy challenge for advancing high-quality health care. Health Affairs. 2003;22(4):147-153. doi: 10.1377/hlthaff.22.4.147
  4. Haber J, Hartnett E, Allen K, et al. Putting the mouth back in the head: HEENT to HEENOT. Am J Public Health. 2015;105(3):437-441. doi:10.2105/AJPH.2014.302495
  5. Bussenius, H., Reznik, D., Moore, C. Building a culture of oral health care. J Nurse Pract. 2017;13(9):623-627. doi: 10.1016/J.NURPRA.2017.07.019

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