Assessing and Addressing Patients' Health Literacy Challenges
February 12, 2010
Most patients are not this open about their inability to understand health education materials because they don't understand the risks of their health literacy deficit. Health literacy is defined in Healthy People 20101 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." Patients often fail to adhere to medical or dietary recommendations because of their poor health literacy. And when providers are unaware of this problem, they are unlikely to teach their patients in ways that empower those patients to successfully manage their health problems.
Inadequate health literacy is a widespread problem. In a large national study conducted in 20032, 14% of adults were determined to be at the lowest level of health literacy (below basic), and 22% were at the next lowest level (basic). Although the majority of participants in this study in the "below basic" level of health literacy had not completed high school, 3% of this group had a bachelor's degree.
Providers should assess the health literacy level of each patient and provide education that is appropriate for that level. It is unlikely that patients will admit that they don't understand health information, so the provider should look for clues, such as patients promising to read education materials when they get home, never having their reading glasses with them, or leaving a lot of blanks on an intake form. When working with patients on the phone, clinicians may be able to identify health literacy deficits if patients frequently put someone else on the phone to speak for them, they avoid reviewing health topics, or if they continue to repeat incorrect medical information even after proper instruction.
What can providers do?
Providing health education through a combination of written materials and verbal communication can help to improve a patient's level of understanding. When using written materials, providers should offer information at the fifth- to sixth-grade reading level or lower. (The patient education materials available from Milliman Care Guidelines, such as the new Discharge Information handouts , are targeted at the sixth-grade reading level.) Providers can tell patients to use the written materials as a guide, and ask them to read back the information to assess their understanding. Another technique is to ask the patient to pretend that they are teaching a friend how to care for a condition or take a medication.
During verbal education sessions, the provider should avoid medical terminology and use commonly understood words instead. In addition, the provider should try not to overload the patient with too much information during each session. It is also important to reinforce desired behavior rather than simply reciting facts. For example, the provider should focus on how and when the patient should take their blood pressure medicine instead of explaining how the antihypertensive works.
It is clear that low health literacy is a serious problem that should be addressed one patient at a time. Assessing a patient's literacy level is the first step in addressing any health knowledge deficit. Use of grade-level-appropriate written materials and open-ended verbal techniques can go a long way toward increasing patient comprehension and empowerment. Improving health literacy can be a powerful tool to transition patients from passive observers to active participants in their health management, and may lead to improved outcomes and lower costs.
1
Healthy People 2010: Understanding and Improving Health. 2nd ed. [Internet] Washington, DC: U.S. Department of Health and Human Services 2000 [accessed 2010 Jan 12] Accessed at: http://www.healthypeople.gov
2
Kutner M, Greenberg, E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy 2006 [accessed 2009 Dec 29] Accessed at: http://nces.ed.gov/pubs2006/2006483.pdf
Comments