HEALTH CARE LITERACY

INTRODUCTION
 Over 300 studies have shown that health
information cannot be understood by most
of the people for whom it was intended,
suggesting that the assumptions made by the
creators of this information, regarding the
recipient’s level of health literacy, are often
incorrect
 Our current healthcare system is undergoing a
revolution in perspective, challenging itself to
become patient centered and asking individuals to
take an active role in medical decision making,
choosing quality providers, disease self-
management, and safety efforts. 1 The simultaneous
proliferation of pharmaceuticals and the increasingly
complex web of health insurance have significantly
complicated patients’
roles in their own care.
 HEALTH-LITERACY DEFINITION


“ 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.”
 Skills Needed for Health Literacy
 Patients are often faced with complex information and
treatment decisions. Patients need to:


Access health care services

 Analyze relative risks and benefits
 Calculate dosages
 Communicate with health care providers
 Evaluate information for credibility and quality
 Interpret test results
 Locate health information
 In order to accomplish these tasks, individuals
may need to be:
 Visually literate (able to understand graphs or
other visual information)
 Computer literate (able to operate a computer)
 Information literate (able to obtain and apply
relevant information)
 Numerically or computationally literate (able
to calculate or reason numerically)
 Prevalence of Low Health Literacy
 Reasons for limited literacy skills include:
 Lack of educational opportunity -people with a
high school education or lower
 Learning disabilities
 Cognitive decline in older adults
 Economic Impact of Low Health Literacy
 In addition to the effects of low health literacy
on the individual patient, there are economic
consequences of low health literacy to society.
 Improving health communication reduces
health care costs and increases the quality of
health care.
 Functional health literacy has been noted to include “the ability to
understand instructions on prescription drug bottles, appointment
slips, medical education, brochures, doctor’s directions and consent
forms, and the ability to negotiate complex health care systems.”

 To be fully functional, health literacy also requires oral-

communication skills such as being able to articulate symptoms, to
formulate relevant questions, and to convey health history and
current treatment. In addition, health
 literacy in the information age requires quantitative literacy, or
numeracy: the ability to perform computations and reason
numerically
 Health-literate patients thus need to be
able to calculate dosages, interpret test
results, weigh risks and benefits, and evaluate health
information for quality and accuracy.

 Health Literacy and Patient Safety their health-literacy skills

under less-than ideal circumstances, generally, when they are
sick or under the stress of discovering that they or a loved one
have an illness.
These definitions of health literacy are multifaceted, and
providers may see themselves as ill-equipped to improve the
demonstrably poor skills of so many U.S. patients
 When seen from the perspective of providers,
health literacy means the ability to speak and
write clearly when addressing patients.
 Initiatives to Improve Patient
Communication
 Low health literacy was once viewed as an individual patient's deficit-that is, a
patient's lack of knowledge and skills regarding health issues. We now recognize
that health literacy is a "systems issue" , reflecting the complexity of both the
presentation of health information and navigation of the health care system.

 Health literacy issues and ineffective communications place patients at greater

risk of preventable adverse events. If a patient does not understand the
implications of her or his diagnosis and the importance of prevention and
treatment plans, or cannot access health care services because of
communications problems, an untoward event may occur. The same is true if the
treating physician does not understand the patient or the cultural context within
which the patient receives critical information... The Joint Commission's
accreditation standards underscore the fundamental right and need for patients
to receive information - both orally and written - about their care in a way in
which they can understand this information
 Research Findings on the Impact of Low
Health Literacy
 Below are just a few of the conclusions from studies on health literacy and
outcomes.
 People with low health literacy have a lower likelihood of getting flu shots,
understanding medical labels and instructions, and a greater likelihood of
taking medicines incorrectly compared with adults with higher health literacy.
 Individuals with limited health literacy reported poorer health status and were
less likely to use preventative care.
 Individuals with low levels of health literacy are more likely to be
hospitalized and have bad disease outcomes.
 Inpatient spending increases by approximately $993 for patients with limited
health literacy.
 After controlling for relevant variantes, lower health literacy scores were
associated with high mortality rates within a Medicare managed care setting.
 Cancer:
 Low literacy adversely impacts cancer incidence, mortality,
and quality of life. For example:
 Cancer screening information may be ineffective; as a
result, patients may be diagnosed at a later stage.
 Treatment options may not be fully understood; therefore,
some patients may not receive treatments that best meet
their needs.
 Informed consent documents may be too complex for many
patients and consequently, patients may make suboptimal
decisions about accepting or rejecting interventions.
 Diabetes


Among primary care patients with Type 2 diabetes,

inadequate health literacy is independently
associated with worse glycemic control and higher
rates of retinopathy. Inadequate health literacy may
contribute to the disproportionate burden of diabetes
related problems among disadvantaged populations.
HEALTH LITERACY
AND PATIENT SAFETY
 The literature is replete with anecdotal evidence of a strong link
between health literacy and patient safety. From the illiterate
patient who nearly bleeds out after misunderstanding his
doctor’s instructions about taking a blood thinner, to the mother
who pours an
oral antibiotic into her child’s infected ear, to
the Spanish-speaking patient who receives
another man’s medication because he incorrectly nods in
response to an identification question asked in English, these
stories illustrate the concrete and commonplace medical errors
that result from a failure to implement health-literacy
initiatives.
 As the IOM report “Health Literacy: A
Prescription to End Confusion” noted, limited
health literacy has already been linked to
problems with chronic-illness management,
patient involvement in decision making about
treatment,
lower adherence to certain therapy regimes,
and lower self-reported health status.
 A link has also been demonstrated between low-literacy
patients and increased
medical expense. Although it is hardly surprising that
poor management of chronic illness or failure to adhere to
therapy plans
creates additional expense for the health-
care system, the IOM report and others
have suggested that low-literacy patients
have higher hospital-utilization rates, higher
use of emergency services, and higher
inpatient-spending rates.
HEALTH-LITERACY DATA


It is not always easy to determine which patient has low

literacy. These patients may have spent years developing
sophisticated masking and coping strategies. These
patients may be articulate and present well.
One study of low-literacy patients suggested that low-literacy
patients are not likely to front this information with healthcare
providers. Another study revealed that clinic physicians
accurately identified only 20% of their low-literacy patients. 8
Patients themselves may think that their health-
literacy skills are adequate, but they may
simply not .
CONCLUSION


The lesson from these studies is twofold.

Firstly, health-literacy efforts must be implemented universally
and contain behavioral and communication changes that
improve clarity of communication regardless of the literacy
level of the patient or the accuracy of the perceptions of the
provider
 Secondly, specific data about populations that may be
particularly vulnerable to low health literacy can help
providers focus their self assessment of patient safety issues on
those patients at highest risk for communications related errors
 The assessment measured literacy by asking participants to complete
literacy tasks, as opposed to self-reporting literacy,
drawn from actual health-related materials.
 The assessment was thus designed to capture the true functional
literacy of participants in real-life contexts. The assessment was also
designed to measure different types
of literacy, each of which reflected skills required to comprehend and
properly process health information. The assessment measured prose
literacy (basic reading and
comprehension), document literacy (the ability to search and read
through longer, non-continuous text), and quantitative literacy (the
ability to perform computations using numbers embedded in print
materials