“But I don’t understand…” Facing the Challenges of Health Literacy
Health literacy is defined as the ability to read, understand, and follow basic medical instructions. The Institute of Medicine reports that 90 million people (over 50 percent of American adults) have difficulty understanding and interpreting health information.1 Low health literacy affects an individual’s ability to communicate with health care providers, adhere to multiple drug regimens, make informed decisions about care, and determine when and how to seek medical treatment in a complex healthcare system. In addition, "low literacy is associated with several adverse health outcomes, including low health knowledge, increased incidence of chronic illness, poorer intermediate disease markers, and less than optimal use of preventive health services."2
An illustrative example of the consequences of low health literacy was recently published in the Annals of Internal Medicine. Researchers studying the ability of patients to take medications correctly found that approximately two-thirds of the patients surveyed were able to read the label, but only 34.7 percent could demonstrate the number of pills to be taken daily.3
How can healthcare providers work towards overcoming this challenge?
• Understand the importance of health literacy
The Joint Commission discusses possible solutions to overcome low health literacy and provides 35 recommendations to protect patient’s safety in the white paper "What Did the Doctor Say?": Improving Health Literacy to Protect Patient Safety, released in February 2007. This document is available electronically at <www.jointcommission.org>
The American Medical Society Foundation developed a health literacy kit, available for order at <www.ama-assn.org/ama/pub/category/8115.html>. Included are videos, manuals, and educational tools to assist healthcare providers in identifying and providing care for patients with low health literacy.
• Encourage patients to ask questions
ASK ME 3TM <www.AskMe3.org>, a tool created by the Partnership for Clear Health Communication, is designed to improve communication between patients and health care providers. Patients are instructed to ask their nurses, doctors, or pharmacists three questions: What is my main problem? What do I need to do? Why is it important to me?
• Provide easy-to-read health materials for patients
MedlinePlus, from the National Library of Medicine, offers easy-to-read, printable patient information. <www.nlm.nih.gov/medlineplus/easytoread/easytoread_a.html>
For additional information on health literacy or for assistance with finding patient handouts, consult with a librarian at the patient family resource centers located at Children's Hospital of Pittsburgh Library, Hopwood Library at UPMC Shadyside, or Western Psychiatric Institute and Clinic Library.
--Michele Burda
1. Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, D.C.: National Academy Press; 2004.<www.iom.edu/CMS/3775/3827/19723.aspx>.
2. Agency for Healthcare Research and Quality Publication No. 04-E007-2, Evidence Report/Technology Assessment, Number 87, "Literacy and Health Outcomes," January 2004.
<www.ahrq.gov/clinic/epcsums/litsum.htm>.
3. Davis, TC, Wolf, MS, Bass, PF III. Literacy and Misunderstanding Prescription Drug Labels, Ann Intern Med. 2006; 145:887-894.
