This Learning Toolbox focuses on health literacy as an important determinant of health equity and outcomes. It includes a quick primer on health literacy, and provides links to articles, tools, and resources to improve the health literacy of organizations and patients.
What is health literacy?
Health literacy is commonly defined 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.” Healthy People 2030 proposes a new definition: “Health literacy occurs when a society provides accurate health information and services that people can easily find, understand, and use to inform their decisions and actions.” Personal health literacy includes all of the skills that individuals use to manage their health, including reading and writing skills, math skills, basic understanding of science and physiology, ability to understand and interpret charts and graphs, and ability to navigate an increasingly complex medical and insurance system. Organizational health literacy includes the skills that health care providers, hospitals, clinics, insurance companies, and others involved in healthcare use to communicate with their patients.
The Health Literacy Problem
Given the complexity of today’s healthcare system, it is not surprising that many, if not most, individuals struggle at times to manage their health and healthcare. What is surprising is the scale of the mismatch between American adults’ health knowledge and literacy skills, and the health communications that they receive. According to the National Assessment of Adult Literacy, almost 40 percent of American adults lack the necessary skills to make informed decisions about their own health. National estimates show that increased annual health care expenditures in the U.S. potentially associated with low health literacy are $215 billion.
40% of American adults lack necessary skills to make informed decisions about their health.
This mismatch has serious implications for health. Low health literacy skills are consistently associated with poorer health outcomes, higher health care costs, increased hospitalizations, lower patient engagement and higher mortality. Even people with higher levels of education can lack the health knowledge to understand their condition and make informed decisions. Because people are often hesitant to admit what they do not know, doctors remain unaware of how much of their communication has been misunderstood. Simple misunderstanding is a major cause of so-called “patient non-compliance.” When providers find ways to communicate more effectively with patients, adverse health outcomes are more likely to be avoided.
$215 billion: Increased annual health care expenditures in the U.S. potentially associated with low health literacy.
Health Literacy and Health Disparities
Racial and ethnic minorities, people with lower socioeconomic status and educational attainment, non-native English speakers, and the elderly are disproportionately affected by issues related to health literacy. According to the National Assessment of Adult Literacy, Whites and Asian Americans have the highest average health literacy of any racial group in the U.S., while Hispanics score the lowest. Those with a bachelor’s degree score higher than those without, while 49% of people who did not finish high school had “below basic” health literacy, the lowest score category. Adults over age 65 have significantly lower health literacy than any other adult age groups.2
Additionally, health literacy is directly connected to self-reported health status. At decreasing levels of self-reported health, people also had lower levels of health literacy, and therefore less ability to manage their care.2 In other words, those who are already at a social and economic disadvantage have worse health because of it, and less capacity to manage their health, leading to a self-perpetuating feedback loop of poverty and illness.
Improving Communication Between Providers and Patients
Health literacy is not just a literacy problem. It represents a communication mismatch between healthcare providers and the people they serve, with effort needed on both sides in order to close the gap.
Effective provider-patient communication is a cornerstone of patient-centered care. Patients and caregivers bear much of the day-to-day responsibility for maintaining their own health. In order to make good decisions, they need to understand how to take their medications, how to monitor their own chronic conditions, how to recognize the signs of a worsening issue, and when to seek additional help. When providers communicate this information in a way that is clear and understandable, they improve the chances that their patients will be able to manage their condition successfully, leading to better health outcomes, higher patient satisfaction and lower health care costs.
Barrier to Health Literacy
People are often hesitant to admit what they do not know and doctors remain unaware of how much of their communication has been misunderstood.
Solution to Barrier
Use the Teach-Back Method to check understanding of key points before patients leave the office.
Providers can improve communications with patients by:
- Using the teach-back method to check understanding of key points before patients leave the office
- Simplifying the language used in written materials to a sixth-grade reading level
- Having staff on hand to assist patients with intake forms
- Following up with patients a day or two after hospital discharge to make sure they understand how to manage their at-home care
- Performing “brown bag” medication reviews to clarify how to take medications appropriately, and to eliminate outdated or duplicate prescriptions
- Providing interpreters and translated materials for people with limited English proficiency (LEP) and patients with hearing/vision disabilities in their preferred format
- Redesigning prescription labels to make dosage instructions simpler, easier to see and read
- Reevaluating signs and maps to make sure that first-time visitors can easily locate their destinations
- Ensuring that no one is asked to sign a consent form without understanding its contents
What resources are available to help with this work?
The following pages include articles, websites, toolkits and other resources that will be of interest to those providers and organizations dedicated to improving health literacy and reduce disparities in their own communities and improving the care they provide to their patients.