Monday, April 06, 2020

Thinking about Health Literacy to Improve Outcomes




Brandie N. Elizaitis, MS, CDP, CDS

Health literacy, per the Institute of Medicine, refers to the degree to which an individual possesses the capacity to obtain, process and comprehend basic health information and services in order to make appropriate health decisions (Committee on Health Literacy, 2004). This literacy is not limited to reading written materials that contain healthcare-related information, nor is health literacy determined only by measuring an individual’s ability to read, comprehend and process health-related information (Andrulis & Brach, 2007). Instead, as Andrulis and Brach note, health literacy is dynamic and changes based on both an individual’s level of capacity to understand information as well as the demands that information provided puts on an individual’s ability to interpret and understand it. This means that while an individual may be able to comprehend basic health information, such as understanding that his or her fever may be a symptom of an infection, that same individual may not understand what it means to have cancer of the lymph nodes. Comprehension may become even more problematic when a diagnosis is first revealed or when stress levels are higher.
Why Health Literacy Matters
Compared to those with proficient health literacy, individuals with low health literacy have lower use of preventative healthcare services, higher rates of hospitalization, worse self-management skills and lower levels of health knowledge (Wolf, Gazmararian, & Baker, 2005). This emphasizes the need for healthcare practitioner recognition that limited health literacy can impact health outcomes, and as such, health literacy is considered one of the social determinants of health. Overall, health literacy has been found to be a stronger predictor of an individual’s health status than racial or ethnic group, employment status, income level or education level (Güner & Ekmekci, 2019). Health literacy is also considered to be distinct from general literacy and is not based on education level, since someone may have a college degree, but may not necessarily have proficient health literacy.
 In the United States, the incidence of poor levels of health literacy is staggering. The first National Assessment of Adult Literacy (NAAL) that included health literacy-related assessment items was first administered in 2003, and found that only 12% of adults ages 18 and older had proficient health literacy (Office of Disease Prevention and Health Promotion, 2008). When the statistics are broken out by race, the numbers are even more concerning. For instance, compared to approximately one-quarter of Caucasian adults, more than half of African Americans, nearly half of Alaskan Native/First Nations, and two-thirds of Hispanic Americans were found to have limited health literacy (Andrulis & Brach, 2007), indicating that racial and ethnic factors can contribute to lower health literacy.
Panagioti et. al note that focusing on improving health literacy is important because unlike other socio-demographic characteristics, it appears that health literacy can be improved, which can lead to better outcomes (Panagioti et al., 2018). Healthcare practitioners who understand the variable levels of health literacy that their patients may have will be able to alter their interactions with individuals who have limited health literacy by recognizing that this group will be less likely than others to understand basic health information, such as medication names, dosages and administration frequencies (Jiang, Sereika, Lingler, Tamres, & Erlen, 2018; Pacleb, Randall, Neubeck, Lowres, & Gallagher, 2018).
Who is at Risk for Limited Health Literacy?
Since health literacy levels can be impacted by social and other circumstances, it is essential to recognize that health literacy issues can potentially impact most adults at some point in their lives. However, there are certain groups who are more likely than others to have limited health literacy. Per the United States Department of Health and Human Services, these groups include:
·       Adults age 65 and older
·       Members of non-white racial and ethnic groups
·       Non-native English speakers
·       Individuals living at or below the poverty level
·       Individuals with education levels of less than a high school degree
·       Refugees and immigrants (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2008)

Healthcare providers who are aware of potential comprehension limitations are better equipped to recognize the need to provide more “user-friendly” information to care recipient. Information should be presented in plain, non-medical jargon when possible, and follow-up to ask if the individual has understood the information should be conducted (Güner & Ekmekci, 2019). Essential information should be provided before other information, and efforts should be made to ensure that other distracting information is minimized. It is important to recognize that individuals undergo several steps during a health care encounter, including trying to remember the instructions that they have been provided, understand information related to health insurance and then remember and implement the healthy behaviors that their practitioner has recommended (Serper et al., 2014).
About the Author
Brandie N. Elizaitis, MS, CDP, CDS, is a graduate student at Saint Joseph’s College of Maine. She is Director of Operations for CMS Compliance Group, Inc., a regulatory compliance and quality improvement consulting firm working with post-acute and long-term care providers. She holds a Master of Science in Dementia and Aging Studies with a concentration in Long-Term Care Administration from Texas State University. Brandie is a Certified Dementia Practitioner and a CARES Dementia Specialist.
References
Andrulis, D. P., & Brach, C. (2007). Integrating literacy, culture, and language to improve health care quality for diverse populations. American Journal of Health Behavior, 31 Suppl 1, S122–33. doi:10.5555/ajhb.2007.31.supp.S122
Committee on Health Literacy. (2004). Health literacy: A prescription to end confusion. (L. Nielsen-Bohlman, A. M. Panzer, & D. A. Kindig, Eds.). Washington, D.C.: National Academies Press. doi:10.17226/10883
Güner, M. D., & Ekmekci, P. E. (2019). A survey study evaluating and comparing the health literacy knowledge and communication skills used by nurses and physicians. Inquiry : a Journal of Medical Care Organization, Provision and Financing, 56, 46958019865831. doi:10.1177/0046958019865831
Jiang, Y., Sereika, S. M., Lingler, J. H., Tamres, L. K., & Erlen, J. A. (2018). Health literacy and its correlates in informal caregivers of adults with memory loss. Geriatric Nursing (New York, N.Y.), 39(3), 285–291. doi:10.1016/j.gerinurse.2017.10.008
Office of Disease Prevention and Health Promotion. (2008). America’s Health Literacy: Why We Need Accessible Health Information. Retrieved December 16, 2019, from https://health.gov/communication/literacy/issuebrief/
Pacleb, A., Randall, S., Neubeck, L., Lowres, N., & Gallagher, R. (2018). Health literacy and medication adherence in cardiac disease. British Journal of Cardiac Nursing, 13(11), 545–554. doi:10.12968/bjca.2018.13.11.545
Panagioti, M., Skevington, S. M., Hann, M., Howells, K., Blakemore, A., Reeves, D., & Bower, P. (2018). Effect of health literacy on the quality of life of older patients with long-term conditions: a large cohort study in UK general practice. Quality of Life Research, 27(5), 1257–1268. doi:10.1007/s11136-017-1775-2
Serper, M., Patzer, R. E., Curtis, L. M., Smith, S. G., O’Conor, R., Baker, D. W., & Wolf, M. S. (2014). Health literacy, cognitive ability, and functional health status among older adults. Health Services Research, 49(4), 1249–1267. doi:10.1111/1475-6773.12154
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2008). National Action Plan to Improve Health Literacy. Washington, DC: U.S. Department of Health and Human Services.
Wolf, M. S., Gazmararian, J. A., & Baker, D. W. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165(17), 1946–1952. doi:10.1001/archinte.165.17.1946