The healthcare field is fond of paperwork, reading material, and complex information. Any trip to a healthcare provider typically begins with stacks of forms requiring completion before a patient can be seen by a clinician. Post-surgical information and home exercise plans are often given in written formats. Managing a medical condition often involves medical terminology and the ability to understand complex concepts related to anatomy and physiology. And in order to have low or no copay for appointments, more paperwork is required to search insurance marketplaces and complete enrollment in insurance coverage. What are the consequences if a patient does not have the education level to adequately manage his or her condition or the healthcare system, and what role do we have in alleviating this concern?
According to the Affordable Care Act, health literacy refers to “the degree to which individuals have the capacity to obtain, process, communicate, and understand basic health information and services needed to make appropriate health decisions.”1 Health literacy has a direct impact on several different dimensions of health and wellness. Most patients with low health literacy have worse general health compared to those with high health literacy rates, in addition to higher prevalence of diseases such as hypertension.2,3 Patients with low health literacy also demonstrate decreased access to affordable healthcare options and high rates of emergency room utilization, increasing healthcare spending.3 Several studies have shown that patients with low health literacy do a poor job of managing chronic diseases such as diabetes, which often leads to early mortality.3 These patients are disproportionately lower income with limited English language skills.4 One in three patients treated in the U.S. healthcare system is considered to have low levels of health literacy (36%), and it is estimated that up to 50% of these patients are uninsured.1,3
Given the pervasiveness and clinical impact of low health literacy, how can you adjust your interventions and plan of care to best serve these patients?
Don’t get frustrated with lack of understanding. One study on patients who self-reported low health literacy found that over 40% felt embarrassed by their inability to read forms, and that most of these patients did not feel comfortable admitting this embarrassment to family members.5 Consider that this situation is frustrating for the patient as well, and be willing to give extra time to read or explain paperwork.
Focus on health promotion. Public health measures have helped decrease infectious disease rates, but this same decrease has not been seen with chronic diseases.3 Focusing on preventative wellness through diet and regular physical activity rather than providing complex medical information may be a small step toward decreasing prevalence of chronic diseases such as Type II diabetes.
Offer alternatives. Decreasing the complexity of paperwork, increasing font size, providing pictures, or decreasing words per page may help a patient better understand materials. Adjusting content to be culturally sensitive or translating to other languages such as Spanish will improve comprehension.2
Create a system to improve patient adherence. Patient non-adherence may be as high as 47% among those with low health literacy.2 Design a system to motivate patients and hold them accountable for completing their HEP.
Suggest courses or other education materials. Community courses have been shown to help these patients demonstrate significant improvement on outcomes tools that measure health literacy.4 Be familiar with resources in your area that may offer free classes relating to management of certain diseases, such as community centers, free health clinics, and low-cost counseling services.
As present or future clinicians, our role in addressing the health and wellness of our patients also extends outside of the clinic. Many healthcare providers believe that they are familiar with health literacy despite not knowing how to modify examinations and interventions for this population of patients.3 Special courses or CEU’s focusing on health literacy may improve empathy and give healthcare providers the tools they need to be successful when working with these patients.3 In addition to this, encouraging volunteer work outside the clinic that is directed at community or public health initiatives can contribute to a healthier population. By addressing external factors such as health literacy, we can ensure that our plan of care is both effective and a positive experience for patients.
- Sentell T. Implications for reform: survey of California adults suggests low health literacy predicts likelihood of being uninsured. Health Affais. 2012;31(5):1039-1048. doi:10.1377/hlthaff.2011.0954. http://content.healthaffairs.org/content/31/5/1039.long. Accessed January 25, 2017.
- Geboers B, Brainard JS, Loke YK, et al. The association of health literacy with adherence in older adults, and its role in interventions: a systematic meta-review. BMC Public Health. 2015;15:903. doi:10.1186/s12889-015-2251-y. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573285/. Accessed January 25, 2017.
- Coleman CA, Fromer A. A Health Literacy Training Intervention for Physicians and Other Health Professionals. Fam Med 2015;47(5):388-392. http://www.stfm.org/FamilyMedicine/Vol47Issue5/Coleman388. Accessed January 25, 2017.
- Mas FS, Ji M, Fuentes BO, Tinajero J. The health literacy and ESL study: a community-based intervention for Spanish-speaking adults. Journal Health Commun. 2015;20(4):369-376. doi:10.1080/10810730.2014.965368. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385490/. Accessed January 25. 2017.
- Pleasant A. Advancing health literacy measurement: A pathway to better health and health system performance. Journal Health Commun. 2014;19(12):1481-1496. doi:10.1080/10810730.2014.954083. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292229/. Accessed January 25, 2017.