Health Literacy: A Closer Look

Health literacy is the ability to read, understand and act on health care information.¹
Surprisingly, even patients with good general literacy skills can struggle with health literacy. Healthy People 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."¹

Low health literacy costs the U.S. healthcare system between approximately $106 billion and $238 billion annually.² More importantly, people with limited health literacy are more likely to have poorer health statuses than others.³ Limited health literacy isn't a condition that makes itself easily visible. In fact, you can't tell by looking. Health literacy depends on the context. Even people with strong general literacy skills can face health literacy challenges when:⁴

• They are not familiar with medical terms or how their bodies work.
• They have to interpret numbers or risks to make a health care decision.
• They are diagnosed with a serious illness and are scared or confused.
• They have complex conditions that require complicated self-care.

Key Findings on Health Literacy

Key findings from the National Assessment of Adult Literacy (NAAL) include: ⁴

• Only 12 percent of U.S. adults had proficient health literacy. Over a third of U.S. adults would have difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart.
• Limited health literacy affects adults in all racial and ethnic groups.
• Even high school and college graduates can have limited health literacy.
• Compared to privately insured adults, both publicly insured and uninsured adults had lower health literacy skills.
• All adults, regardless of their health literacy skills, were more likely to get health information from radio/television, friends/family, and health professionals than from print media.

Health literacy is essential to promote healthy people and communities. Health care providers and institutions play a critical role in health literacy as they can make it easier or more difficult for people to find and use health information and services.⁴ Poor communication between patients and clinicians is a major factor leading to malpractice lawsuits. In fact, attorneys estimate that a clinician's communication style and attitude are major factors in nearly 75% of malpractice suits.⁵

What Can Providers Do?
Many tools, techniques and resources are available to doctors, nurses, and office staff to ensure that communication between the health care provider and the patient is as effective as possible.

• Assess the health literacy of your patients--add one or more questions to the patient history process:³
  - Order: Assessing the Nation's Health Literacy
  
  • How happy are you with the way you read?
  • What is the best way for you to learn new things?
  • How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?
  • How confident are you filling out medical forms by yourself?

• Utilize the AHRQ Health Literacy Universal Precautions Toolkit, which includes twenty tools and numerous sample forms.⁶ Popular tools for physician practices include:
  
  • The teach-back method
  • Brown bag medication review
  • Improve medication adherence and accuracy
  • How to address language differences
    -Download a free copy of the toolkit

• Use the "teach-back" technique--Ask patients to explain or demonstrate how they will undertake a recommended treatment or intervention.^3,6 If the patient does not explain correctly, assume that you have not provided adequate teaching. Re-teach the information using alternate approaches.

• Encourage patients to ask questions--Create a shame-free environment in which patients feel comfortable asking questions. Invite patients to bring family members or friends to the visit with them. The Ask Me 3™ program encourages patients and physicians to utilize three basic questions for every visit or contact:⁷
  
  • What is my main problem?
  • What do I need to do (about the problem)?
  • Why is it important for me to do this?
    - Download Ask Me3™ materials for use in your practice

• Play the "Questions Are the Answer" video in your waiting room -- The Agency for Healthcare Research and Quality (AHRQ) offers a free, 7-minute video featuring real-life accounts by actual patients and their clinicians on the importance of two-way communication. This video is ideal for showing in patient waiting rooms, lobby areas or on a website.^1,3 The DVD can be requested by contacting HEQS@highmark.com or 1.866.260.1709. Check out additional information "Questions Are the Answer" materials on AHRQ's website at http://www.ahrq.gov/questions.

• Stay current through health literacy training, such as those offered by:
  
  • The Public Health Foundation, Effective Communication Tools for Healthcare Professionals
  • The Medical Library Association, Prescription for Information: Addressing Health Information Literacy
  • The Centers for Disease Control and Prevention, Health Literacy for Public Health Professionals

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References

1. Center for Health Care Strategies, Inc., "What is Health Literacy?" Fact Sheet, August, 2005, http://www.chcs.org/publications3960/publications_show.htm?doc_id=291711.

2. Vernon, J. et. al. "Low Health Literacy: Implications for National Health Policy." 2007.

3. Weiss MD, Barry D., American Medical Association, "Health Literacy and Patient Safety: Help Patients Understand, Manual for clinicians," Second edition, 2007.

4. U.S. Department of Health & Human Services, Office of Disease Prevention and Health Promotion, Health Communication Activities, America’s Health Literacy: Why We Need Accessible Health Information, http://www.health.gov/communication/literacy/issuebrief.

5. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice: Lessons from plaintiff depositions. Archives of Internal Medicine, 1994; 154:1365-1370.

6. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Health Literacy Universal Precautions Toolkit, 2010. http://www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf.

7. Ask Me 3TM, Partnership for Clear Health Communication at the National Patient Safety Foundation, www.npsf.org/askme3.