Health Literacy: A Life-Threatening Communication Gap

Health literacy, as defined in a report by the Institute of Medicine, is the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment. However, just how many of your patients truly have a handle on their own healthcare needs?

A 2003 survey by the National Assessment of Adult Literacy (NAAL) divided the health literacy skills of subjects into four levels: proficient, intermediate, basic, and below basic. Thirty-six percent of American adults - 78 million people - have only basic or below basic skills resulting in poor compliance with home care instructions, and prescription drugs, misinterpretation of warnings on prescription labels, increased hospitalizations and visits to the emergency room and poor control of chronic diseases.

Difficult to detect

Most individuals with limited health literacy are undetected by the healthcare system writes Barry D. Weiss, MD, University of Arizona College of Medicine, Tucson and author of "Health Literacy and Patient Safety: Manual for Clinicians,” Second Edition, published by the AMA Foundation, (2009). "In fact, patients with limited general literacy skills go to great lengths to hide this from others, some even going so far as to bring decoy reading materials with them to the clinician's office or handing articles about medications or treatments to their clinician. The majority of patients with limited literacy skills," he adds, "have never told anyone in the healthcare system, and most have never even told family members (68 percent have never told their spouses). In other words, you can't tell by looking and you can't expect your patients to tell you."

Red flags

As Dr. Weiss explains, some of the clues or "red flags" indicating patients may have limited health literacy are the following:

Behaviors
• Patient registration forms that are incomplete or inaccurately completed
• Frequently missed appointments
• Noncompliance with medication regimens

Responses to receiving written information
• "I forgot my glasses. I'll read this when I get home."
• "I forgot my glasses. Can you read this to me?"
• "Let me bring this home so I can discuss it with my children."

Responses to questions about medication regimens
• Unable to name medications
• Unable to explain what medications are for
• Unable to explain timing of medication administration

Action steps

Writing in American Family Physician, E.J. Mayeaux, Jr., M.D. and his colleagues, recommend:

• Limit the amount of information you give at one time.
• Prioritize the information you give the patient. The most important information should be repeated first and last.
• Repeat the information in different ways. Demonstrate what you want the patient to do.
• Involve the patient's family members in these discussions.
• The use of nurse-educators to provide one-on-one instructions in busy outpatient settings may efficiently complement physician education.

"Maintain a slow, conversational pace when discussing findings and treatment," advises Patricia L. Elliott, a family practitioner in Rapidan, Va. "Remember that a nonreader usually has a limited vocabulary and scant medical knowledge. You may have to explain how disease is spread, or that the word 'diet' doesn't just mean eating less. Repeat yourself if necessary, then ask the patient questions that will verify comprehension. One approach is to say, 'Just to make sure I explained clearly enough, please tell me exactly how you're going to take this medication and what you're taking it for.'"

Another useful step: train staffers to offer help to patients who need assistance in filling out forms. "Create a welcoming and supportive environment, a sense that you and your staff project that it's OK to ask questions or admit that you don't understand," says Helen Osborne, president of Health Literacy Consulting based in Natick, Mass., and author of Health Literacy From A to Z: Practical Ways to Communicate Your Health Message (Jones and Bartlett Publishers, 2005).

"Simply raising awareness of low health illiteracy as a significant problem is definitely an important step in the right direction," says Ruth Parker, M.D., associate professor at Emory University School of Medicine. "For healthcare providers, just understanding the problem and taking a little extra time to make sure patients can understand what they need to do can be an enormous help."

Resources

For further information, the AMA Health Literacy Educational Toolkit, 2nd ed. and accompanying instructional video (for which AMA PRA Category 1 Credit™ can be earned) is available at www.AMABookstore.com or call (800) 621-8335 and mention AMA Bookstore Item #OP221407.

Bob Levoy is the author of seven books and hundreds of articles on human resource and practice management topics. His newest book is "222 Secrets of Hiring, Managing and Retaining Great Employees in Healthcare Practices" published by Jones & Bartlett. He can be reached at blevoy@verizon.net.