According to the Centers for Disease Control and Prevention (CDC), the Affordable Care Act defines health literacy as “the degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions.” This is why patient health literacy can have such a significant effect.
Institutions and providers alike should strive to promote health literacy and to ensure that patients of all levels of health literacy can access high-quality care.
Health literacy and outcomes
Many factors can contribute to low health literacy. It’s typically associated with lower socioeconomic status, language proficiency and education level, along with older age. This means that health literacy levels are often a manifestation of systemic issues that contribute to health inequity and injustice.
Low health literacy can pose a significant barrier to high-quality care and has been linked to poor health outcomes. For example, patients may have increased difficulty managing chronic diseases. A study published in the Journal of Public Health Management and Practice found that patients with diabetes who “found it difficult to get health advice or information” were less likely to receive appropriate diabetic management in areas including hemoglobin A1c testing, foot exams and dental visits.
Additionally, low health literacy can contribute to difficulty following medication regimens. For example, providers may prescribe steroid inhalers to patients with asthma, telling them to use the inhaler daily. If patients don’t understand how the class of medications work, they may instead take the medication only as needed and may not receive the intended therapeutic benefit.
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Addressing low health literacy
Both institutions and providers can take steps to improve patient health literacy and deliver high-quality care to patients regardless of their health literacy levels.
Systems-level improvements are a key component of delivering better care for patients with low health literacy. Organizational health literacy, or the efforts institutions make to promote accessibility of information and care for all patients, is a key component. The CDC provides a comprehensive framework for institutions to develop plans to improve organizational health literacy, including ensuring that institutional websites and brochures are accessible to patients.
One study published in Transplantation attested to the link between access to information and access to care. Researchers found that transplantation centers with websites with higher understandability scores had greater proportions of patients with lower education levels on their transplant lists.
In addition to institutional improvements, efforts by providers are also necessary in order to improve health literacy for patients. Consider the following four ways to tailor your communication according to each patient’s level of health literacy:
- Avoid making assumptions about healthcare knowledge. It may be helpful to ask a patient about their understanding of a disease early on. You can also assess patient health literacy simply by saying, “A lot of people have trouble reading and remembering health information. Is this ever a problem for you?”
- Use teaching techniques. Consider using the teach-back method, which involves asking patients to tell you about their treatment plan. This can help ensure that an effective exchange of information has taken place.
- Allow patients to ask questions. Answering questions is a crucial way to ensure your patient knows what they need to. Especially if they feel insecure or nervous, some patients may be hesitant to ask for more information or clarifications, so be sure to encourage it.
- Focus and summarize. Avoid unnecessary medical jargon and advanced vocabulary words. Consider emphasizing two to three of the most important points and summarizing them at the end of the encounter.
Above all, remain alert for opportunities—either in your personal interactions or at the level of your institution’s communications — to provide inclusive care to all patients.