This study aimed to assess knowledge and practice of supporting health literacy for older adults among community care workers, and it shows that a limited number of staff members of community-based integrated support centers know the term and definition of health literacy. Although a vast number of Japanese studies recently reported health literacy, and the Ministry of Health, Labor and Welfare also advocate health literacy and health communication on the website [24], more than 60% of respondents did not know the term of health literacy. Several studies in other countries also reported that majority of health professionals were unfamiliar with the term health literacy [16, 17]. Nurses may have had more opportunities to learn about health literacy-related topics, such as health communication and health education, in their graduate institutions; however, nearly 50% of them answered that they heard about health literacy for the first time, and this number is lower than previous study [17]. Moreover, more than half of the respondents and approximately 40% of respondents did not use teach-back methods or visual materials in their health literacy work, respectively. Improving basic knowledge of health literacy, including its definition and relationship with health outcomes, is important, because this study revealed that knowledge of health literacy is positively associated with the practice of health literacy among the respondents. In addition, a lower percentage of respondents know that health literacy may be associated with a limited number of respondents using appropriate communication techniques for individuals with lower health literacy levels [25, 26]. Limited knowledge of health literacy among care workers may be a barrier to support clients’ health literacy. Previous research has suggested that poor communication skills of health professionals undermine the opportunity for participants to make use of their health literacy skills in consultations and created a barrier to exchanging information [1]. Due to declining hearing and vision loss may contribute to a decreased ability process health information among older adults [27]. Moreover, older adults with limited health literacy consequence experience more difficulties in participating in care consultation [28]. Therefore, improving care workers’ communication skills such as using visual materials and teach-back methods is needed to empower older adults in their primary care.
The study found that the perception and practice of health literacy and communication differed by professional qualifications, and was significantly lower among social workers than among nurses. The reasons for this result may be related to the beliefs of social workers that their responsibility is more in terms of welfare than health, and they may relegate supporting clients with low health literacy to nurses. Teaching about health literacy, including the definition of health literacy and discussing techniques for clear communication, are recommended to a broader range of healthcare workers. This is because health communication and information were usually provided by various health staff, including administrators [29]. Moreover, community-based integrated support centers play a central role in providing comprehensive care, including health, long-term care, and social welfare; health literacy skills are required not only for nurses, but also care managers and social workers. The staff of centers need to put in efforts to improve their communication skills, because all of them have equal opportunities to consult and provide reliable information for older adults. Moreover, people with limited health literacy may have limited knowledge and understanding of health that reduces their quality of life [30] and their autonomy in self-care and decision making [31]. The goal of a community-based integrated care system is that older adults live in familiar places with having their dignity, even if they need long-term care. Social workers also require empowering older adults to become more self-assured as they act on their health information, advocate for greater clarity of health information, and learn to navigate the healthcare system more effectively [32].
We also found that the work experience of the respondents was also associated with health literacy scores. Training should also be targeted towards freshers. Several recent studies have evaluated health literacy training for care providers [33, 34]. According to these findings, further study is required to develop and evaluate health literacy training for the staffs of community-based integrated support centers.
This study, to the best of our knowledge, is the first survey to assess the health literacy of the staff of community-based integrated care centers. However, due to the low respondence rate and targeting support centers in two prefectures, the results of the study may not be generalized to all community care workers in Japan.