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
