- Kenny Lin, MD, MPH
In the July 15th issue of AFP, associate medical editor Barry Weiss, MD shares an anecdote about a hospitalized patient's confusion about a conversation between himself and a consultant who said that it was okay to move her from the intensive care unit to the floor. The perplexed patient interpreted "floor" literally to mean that the hospital was so overcrowded that she would not be able to sleep in a bed! Although this mildly comical story might elicit chuckles at health professional gatherings, it also highlights the serious potential for limited health literacy to lead to misunderstandings between doctors and patients.
Health literacy encompasses essential skills that patients need to access health services, understand and apply health information, and make good decisions: reading, writing, numeracy, and communication. A large body of evidence demonstrates strong associations between low health literacy and poorer health outcomes; compared to patients with high health literacy, patients with low literacy have more hospitalizations, more emergency department visits, and are less likely to receive appropriate preventive and chronic care services. According to a clinical review by Dr. Lauren Hersh and colleagues, "More than one-third of U.S. adults, an estimated 80 million persons, have limited health literacy, making it more difficult for them to read, understand, and apply health information. ... Although U.S. adults on average read at an eighth-grade level, more than 75% of patient education materials are written at a high school or college reading level." Limited health literacy is more common in patients age 65 years and older and in minority populations.
How can family physicians make sure their patients understand health information? Rather than routinely screening for low health literacy, which has not been shown to improve outcomes, Dr. Hersh and colleagues recommend taking "universal health literacy precautions," a group of strategies for enhancing verbal and written communication, and visual aids (including online videos). For example, clinicians can use "teach back" to ask patients to restate the medical concept or plan in their own words to confirm understanding. Online tools are available to quickly assess the reading level of written patient materials. Patients also benefit from being encouraged to participate actively in formulating their care plans and being connected to community literacy resources, if needed.
For more information on how to bridge the health literacy gap with your patients, see this recent Family Practice Management article and the Agency for Healthcare Research and Quality's Health Literacy Universal Precautions Toolkit.