Poor Health Literacy – Hazardous to Patients’ Health
An elderly woman sent home from the hospital develops a life-threatening infection because she doesn't understand the warning signs listed in the discharge instructions. A man flummoxed by an intake form in a doctor's office reflexively writes "no" to every question because he doesn't understand what is being asked. A young mother pours a drug that is supposed to be taken by mouth into her baby's ear, perforating the eardrum. And a man in his 70s preparing for his first colonoscopy uses a suppository as directed, but without first removing it from the foil packet.1
As defined by the Institute of Medicine, low health literacy is an inability to obtain, process and understand basic health information and services needed to make appropriate health decisions.2 More than 90 million people, nearly half of all American adults, have difficulty understanding and using health information. In many cases, poor health literacy is “a stronger predictor of health than age, income, employment status, education level and race.”3 Patients with poor health literacy are also more likely to make medication errors, have excess hospitalizations, longer hospital stays and make more emergency room visits.
Ultimately, low health literacy can create barriers of communication, leading to both patient dissatisfaction and provider frustration. There are a few quick and easy steps you can take to help ensure your patients understand what you are telling them. For example:
- Assume everyone may have difficulty understanding (regardless of education or reading level). Everyone is at least a little nervous during medical encounters. Make medical information easier to read and understand. When appropriate, show or draw pictures, or use videos.
- Communicate in an easy to understand manner:
- Speak slowly and clearly to give your patient time to digest information.
- Use plain, non-medical language and avoid jargon and acronyms, such as CAT scan and HDL.
Basic information about a colonoscopy, as perceived by a patient with limited literacy skills:4
Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.
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- Provide context for numbers and mathematical concepts. Measurements such as cholesterol or glucose levels have little meaning to patients unless you put them into context. For example, "Your cholesterol level is 305. A healthy cholesterol level would be less than 200, so we need to talk about how we can lower your number."
- Be an active listener. Allow patients to tell their story. Respond with a short summary: So, what you are saying is ...
- Address quizzical looks. This is likely a sign the patient does not understand what you are explaining.
- Use teach-back or show-me techniques. Ask patients to repeat in their own words what they need to do when they leave your office. Limit the amount of information provided and repeat it.
Help our beneficiaries maintain and improve their health by making sure your practice does everything you can to engage and educate them. For additional information on health literacy, visit the U.S. Department of Health and Human Services Health Literacy resources page.
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1. Boodman, Sandra. Many Americans Have Poor Health Literacy. The Washington Post, Feb 2, 2011.
2. The Institute of Medicine. Health Literacy: A Prescription to End Confusion. Committee on Health Literacy: Institute of Medicine of the National Academies. 2004.
3. Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association, JAMA, Feb 10, 1999
4. Health Literacy: The Missing Link in Patient-Physician Communication. AMA-MSS Subcommittee on Health Literacy and Community Service Committee.
