Every year, a lot of money is spent educating people through public health campaigns, yet Malta is still one of the worst in the EU for the rate of problems such as obesity and diabetes.

Where precisely is the flaw in the system?

The Office of the Commissioner for Mental Health and Older Persons has commissioned Malta’s first health literacy survey to get a snapshot of how “health literate” the Maltese are.

“There are four stages to health literacy. It is the ability to access, understand, appraise and apply health information,” Commissioner John Cachia explained.

“We tend to think that just because we post material onto a website or distribute pamphlets, people actually understand what is written and that, moreover, they are able to evaluate what applies to them and what doesn’t and then actually put it into practice.

We’ve been talking about obesity for donkey’s years and yet the problem persists

“So we’re not just talking about merely understanding information but we’re also looking into whether people would actually change their habits because of the information they received.”

Dr Cachia and the assistant director responsible for research, Natasha Barbara, were originally interested in commissioning the research in order to understand the profile of the people they were serving – mainly elderly people and people with mental health problems. However, the findings will provide a snapshot of the general population in Malta and will be of value to policy makers, people planning primary healthcare services and people looking at health promotion and disease prevention.

“We would like to understand why people are not acting on the information they are receiving,” Dr Cachia said.

“Is there a block somewhere? There must be because we’ve been talking about obesity for donkey’s years and yet the problem persists. At which stage is the message being blocked?

“If you know that you should be testing for glucose if you have a family history of diabetes, what is stopping you from going? Is it fear?

“Everybody knows that having a family history of breast cancer and glaucoma, for instance, increases an individual’s susceptibility. Are people checking themselves?

“We know that 30 per cent of women have not come forward for breast cancer screening in this country. Why?”

Policy makers and healthcare professionals would need to adopt a different strategy according to where the problems were erupting, he explained.

If the difficulty turned out to be one of access to information, the authorities would need to change the way they were conveying the message, the medium used as well as the language.

“I very much believe in targeting messages. If I wish to address elderly people aged 70 plus, I can’t use the same mechanisms as I would to address 16-year-old youths.

“The content would be the same but the methodology used should be tailor-made.”

Taking the example of mental health services, he continued, the service offered at Cospicua would need to be different from that offered in St Paul’s Bay, which had a strong ethnic component.

“Should we be using the same service development across the board?”

Some eight European countries have conducted surveys identifying their people’s health literacy.

On average, a worrying 47 per cent were at risk of low health literacy.

Having a good level of education does not automatically mean that one was health literate, Ms Barbara explained.

There were a multitude of social determinants which affected this rate. Parents’ attitudes and habits often fed into their children.

As a result, she continued, people with a low level of health literacy ended up not knowing how to access services, made wrong health decisions and were not capable of self-medication.

“People with low health literacy do not realise they are sick and present themselves to their GP when it is often far too late to do anything about their situation.”

The results of the health literacy study will be published by the end of the year.