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THE PHILIPPINE WOMEN’S UNIVERSITY

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HEALTH LITERACY TRAINING NEED FOR THE MEDICAL TECHNOLOGIST: AN ASSESSMENT

CHRISTINE R. GUERRERO

Submitted in Partial Fulfillment of the Course Master of Science in Health Systems Management The Philippine Women’s University Manila October 2019

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THE PHILIPPINE WOMEN’S UNIVERSITY TABLE OF CONTENTS Title Page

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Approval Sheet

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Acknowledgement

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Abstract

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Chapter

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THE PROBLEM AND ITS BACKGROUND Introduction

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Background of the Study

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Research Locale

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Statement of the Problem

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Hypothesis

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Scope and Limitation of the Study

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Significance of the Study

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Definition of Terms

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Acronyms

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REVIEW OF RELATED LITERATURE AND STUDIES Related Literature

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Foreign

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Local

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Related Studies

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Foreign

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Local

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Synthesis

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Conceptual Framework

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METHODOLOGY Research Design

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Participants of the Study

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Data Gathering Procedure

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Statistical Data Analysis and Treatment of Data

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Chapter 1 THE PROBLEM AND ITS BACKGROUND Introduction According to the U.S. Department of Health and Human Services (HHS) (2010), Health literacy is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Literacy gives us the skills to understand and communicate health information and concerns. Among these health literacy skills are the ability to read and understand a nutrition label or able to getting a flu shot, and knowledge on patient preparation for laboratory tests and etc. On the other hand, low health literacy is a health care system problem worldwide not only in the Philippines but even in first world country like the United States even that have a Health Literacy law which governs and promote national health literacy. Although health care professionals are reluctant to acknowledge it, instructions using typical medical terminology are at a level beyond the comprehension of most patients (Doak, Doak & Root, 1996) and although Filipinos take pride in the country’s high literacy rate, this high literacy rate, however, does not automatically translate to a high health literacy rate among them. The level of health literacy is a major factor in the issue of significantly decreasing the number of unhealthy and sick Filipinos (Gloor 2014).

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The efforts to integrate health literacy into the health care system must include all health care professionals including Medical Technologists (NielsenBohlmanet al., 2004) because the medical technologists are part of the health care team and public health system that are primarily responsible for improving health literacy but more importantly because of the current transition of medical “technologist” to becoming medical laboratory “scientist” that require a higher level of knowledge than what is usual.

Background of the Study Health literacy is one of the training needs of Filipino medical professionals, the medical technologists in particular, specially with the current job title and job description transitioning from medical “technologist” to medical “laboratory scientist” thus the need for workforce upskilling and additional training and education, with the help of the newly implemented CPD Law or the Continuing Professional Development Act of 2016 and with the demand of recently signed Universal Health Care Act 2019 into law that will ensure an implementing rules to raise the health literacy of the Filipinos over the comings years under the Health Education and Promotion. Health literacy often involves cultural and linguistic competency. Culture affects how people communicate, understand, and respond to health information. To be

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culturally and linguistically competent in health literacy means it will improve the practitioner’s skills in writing, reading and comprehension, listening and speaking and the ability to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of diverse populations, and to apply that knowledge to produce a positive health outcome such as improved comprehension, clarity in communication and increased competency that will enable the patient to better understand for example, the laboratory tests preparations and guidelines, and laboratory test result interpretation that is used to diagnose, monitor, screen, manage and assess predispositions to diseases, a greater chance to adherence to treatment, proper management to chronic illnesses, ability to engage in self-care, improve health status and greater efficiency and cost saving efficacy to the health system as a whole. Despite the growing interest in health literacy, little research has been done around health professional’s level on health literacy and it’s effect to work performance in the Philippine setting. In this research, I intend to assess the health literacy level of the medical technologists and its effect on work performance and its correlation to health literacy competency that can be one the basis of future health literacy program and curriculum development for hospitals, health care clinics and clinical diagnostic institutions.

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Statement of the Problem The study focused on the health literacy assessment of the medical technologists and it’s correlation to health literacy competency. Therefore, this study will thus seek to answer the following questions: 1. What is the socio-economic job profile of the medical technologists in terms of a. Age b. Gender c. Training and Educational level d. Years of work experience e. Job title position and job description f.

Clinical laboratory level of facility

2. Are there a significant relationship between health literacy skills and clinical laboratory skills? 3. What kind of health literacy training needs is specific, measurable and achievable for the

medical technologists also known as medical

laboratory scientists?

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4. Is there any existing health literacy training program in the Philippines that can answer the previous two questions?

The Null Hypothesis 1. There is no significant relationship between the job competency and health literacy knowledge and skills of the medical technologist. 2. There is no significant relationship between employment, training and educational background on health literacy competency of the medical technologist.

Scope and Limitation of the Study The purpose of the study will be to the assessment and description of the need of health literacy training among registered medical technologist, including the entry-level, mid-career level, chief medical technologist, laboratory supervisor and laboratory manager in selected private and government clinical laboratory facilities as the basis for future training program development.

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Significance of the Study Medical Technologists will be more knowledgeable in health and will be able to effectively communicate health information and thus will truly become what they are now designated as, “medical scientists,” upgrading their health literacy level of competence as scientists. The patients and other stakeholders will be more informed about laboratory health information such as disease diagnosis, laboratory preparation, instructions and procedures and proper laboratory test results understanding and interpretation. Philippine Health care system will be able to develop policy more specific in health literacy under health education and promotion in the long term help save and defray health care cost. The researcher with the results or findings of this study will be to identify the key areas to further strengthen the study to be able to help draft and develop a training program in the future; and in addition, other researchers will have opportunities to continue the research.

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Definition of Terms For clearer understanding of the terms will be used in the study, the following are defined operationally: Cultural and Linguistic Competency — A set of connected behaviors, attitudes, policies that come together in a system, agency, or among professionals for effective cross-cultural work. Health Literacy - is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Illiteracy - means being unable to read or write. A person who has limited or low literacy skills is not illiterate. Levels of Health Literacy - National Assessment of Adult Literacy (NAAL) — A nationally representative assessment of English literacy among American adults age 16 and older. Sponsored by the National Center for Education Statistics (NCES), NAAL is the nation's most comprehensive measure of adult literacy since the 1992 National Adult Literacy Survey (NALS). NAAL Health Literacy Levels:  Below Basic - Adults at the below basic level have only the most elementary literacy skills. These skills range from being non-

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literate in English to being able to locate easily identifiable information in short, commonplace prose text.  Basic Level - Adults at the basic level have the skills necessary to perform simple, everyday activities such as reading and understanding information in short, commonplace texts.  Intermediate Level - Have the literacy skills necessary to perform moderately challenging activities, such as summarizing written text, determining cause and effect and making simple inferences.  Proficient Literacy Level - Have the skills to perform complex activities, such as integrating, synthesizing and analyzing multiple pieces of information. Limited or low health literacy - Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services. Both of these outcomes are associated with higher health care costs. Literacy - Literacy can be defined as a person's ability to read, write, speak, and compute and solve problems at levels necessary to function on the job and in society, achieve one's goals, develop one's knowledge and potential.

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THE PHILIPPINE WOMEN’S UNIVERSITY Acronyms CDC - Centers for Disease Control and Prevention DOH - Department of Health NAAL - National Assessment of Adult Literacy CPD - Continuing Professional Development

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Chapter 2 REVIEW OF RELATED LITERATURE AND STUDIES This chapter presents the relevant literature and studies that the researcher considered in strengthening the claim and importance of the present study.

Defining Health Literacy The U.S. Department of Health and Human Services (HHS) 2010, defines health literacy as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Literacy gives us the skills to understand and communicate health information and concerns. When we apply these skills to a health context, such as reading a nutrition label or getting a flu shot, patient preparation for laboratory tests, it is called health literacy. Dr. Anthony Leachon, president of the Philippine College of Physicians, stated, that when patients come to health care professionals to seek medical advice, they are already very sick. “This should not be the case. This is failure of health literacy,” he explained.

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The US Centers for Disease Control and Prevention (CDC) stated, Health literacy includes the skills and knowledge we have about a wide range of health topics and circumstances. We might need to understand bodily functions, terms for specific health conditions and the ways scientific results and risks are reported. Health literacy also involves cultural influences on both the professional and the public. Health Literacy is A Public Health Priority. Healthy People has identified health literacy as a priority area in disease prevention and health promotion. “In the Philippines, we have failed in health literacy. Why? We have a lot of medical and health knowledge, but many Filipinos fail to comply with what is needed and must be done about their health,” Leachon said. Health literacy involves more than communication between physicians and their patients, or developing written materials in plain language, although these are important components. Health literacy for individuals and communities is essential for understanding a health risk, voting on an environmental issue, recognizing biases in health information reported by the media, or responding to alerts and warnings, such as those for severe weather. Take for instance, Customers buying medications always ask questions which must be properly and appropriately answered by pharmacists.

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“Otherwise, the unanswered questions may lead to a bigger concern, such as self-medication or total disregard of a potential health risk,” Chiong said. Williams (2014) Another example is when laboratories fail to adequately communicate important information to the patients, Inadequate directions or signage to a phlebotomy collection site may prevent access to healthcare, while small print and unnecessarily complex forms can lead to misunderstandings regarding test preparation or interpretation. One group of researchers reported that among patients who have access to their test results, 68% could not interpret a blood glucose value. While labs may feel that this is the provider's role, lab data may be so poorly organized or formatted that patients may easily overlook important findings. (AACC Clinical Laboratory News, para. 5).

Health Literacy Act Several proposed bill to address the low health literacy of the Filipinos was filed, respectively, the Senate Bill No. 2681 of NATIONAL HEALTH LITERACY ACT OF 2008 in the 14th Senate Congress filed on October 16, 2008, the bill again was filed on 15th Senate Congress under the Senate Bill No. 1673 and the latest was Senate 1315, “AN ACT TO ENSURE THAT ALL FILIPINOS HAVE BASIC HEALTH LITERACY SKILLS TO FUNCTION EFFECTIVELY AS PATIENTS AND

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HEALTH CARE CONSUMERS” it is Bill that will benefit all the Filipino citizens to make a sound and timely decision concerning the protection of their health, encouraging the patients and the health providers to avail of preventive medicine instead of curative because preventive medicine is less costly and gives the family less burden than curative, all was introduced and filed by late, Former Senator Miriam Defensor Santiago.

Until recently, the Universal Health Care Law (UHC) or the Republic Act No. 11223 was passed February this year that will ensure to raise the Health Literacy of the Filipinos with the newly established Health Promotion Bureau (HPB) formerly known as HEALTH PROMOTION AND COMMUNICATION SERVICE (HPCS).

The Role Of Philippine Media In Disseminating Public Information On Health Ramon Tuazon, president of Asian Institute of Journalism and Communication and secretary general of Asian Media Information and Communication Center (AMIC) on the information literacy conference conducted by the Department of Health at the University of the Philippines Bahay ng Alumni said, that much of

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Filipinos are over-entertained and under-informed without understanding the effect of some television programs in general. Tuazon said. “Health programs shown in Philippine television showcase more of entertaining, emotionally-driven, rather than truly educating and pushing the meaning of public service,” “Due to consumerism and commercially-driven stories as purpose of media especially in public service that will make the audience more of entertained rather than informed and educated, the public preference became also more of entertainment over information and education,” Tuazon also explained that the level of health literacy in the Philippines is low because media messages that are supposed to create public understanding and knowledge on health, are much of for awareness and not for real application. A suggested community-based health delivery interventions creating innovative heath promotion initiatives on how to capacitate Health Education and Promotion Officers also known as (HEPO) were presented in the conference. The suggested Initiatives are: 1.) To popularize the technical terms without diluting intended messages. In contrast, the CDC suggests not to use technical or medical terminology.

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Words such as pandemic, immunize, transmit, influenza, and prevalence are examples of words that are often misinterpreted. 2.) Create media platform for specific target audiences or as the CDC emphasized that it should be participatory and user-centered. 3.) Educate the mother, family and community through mobile health applications promoting health literacy. The CDC listed the strategies including, use culturally and linguistically appropriate messages, consider the current literacy level of the intended audience, and design messages based on that level, improve the usability of health information making the messages more understandable. A similar suggested action was emphasized by Prof. Williams, MD in about the important roles of a health provider such as the Medical Laboratory Technologist in health communication and literacy.

Health Literacy For Health Professionals Public health professionals play a critical role in ensuring that the public receives reliable, accurate information that will help individuals make informed decisions about their health. Working with media, community organizations, and other stakeholders to disseminate clear, actionable information can decrease the

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likelihood of conflicting messages and lead to a coordinated effort to reach intended audiences. (CDC Health Literacy Training. (n.d.)).

Health Literacy of Medical Technologist As consumers take on more responsibility for their own health, health literacy is fast becoming a patient safety issue that is relevant to clinical laboratory services. In an interview, Professor Mark V. Williams, MD, FACP, FHM, a national expert on health literacy, and the chief Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in E...