HEALTH LITERACY
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What is health literacy?
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Scope of the problem
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Why is health literacy important?
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What can we do to help?
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Resources
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What is health literacy?
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Definitions of Health Literacy
• US Department of Health and Human Services, Healthy People
2010
“ Health literacy is the degree to which individuals have the capacity to
obtain, process, and understand basic health information and
services needed to make appropriate health decisions.”
• American Medical Association
“ A constellation of skills, including the ability to perform basic reading
and numerical tasks required to function in the health care
environment.”
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Definitions of Health Literacy
• Office of the Mayor (New York City)
“Health literacy is the ability to read, understand and act upon health
related information. Health literacy also refers to the capacity of
professionals and institutions to communicate effectively so that
community members can make informed decision and take
appropriate actions to protect and promote health.”
• Health Literacy Network
“The ability to find, understand and use the health information we
need to take care of ourselves and to improve our health and
wellbeing.”
• Rima Rudd, MSPH, ScD; Harvard School of Public Health
“The ability to use language to solve health-related problems at a
proficiency level that enables one to function, achieve one's 4
health goals and develop health knowledge and potential.”
Health literacy depends on both
individual and systemic factors
1. Communication skills of lay people and professionals
2. Patients' knowledge of health topics
– causes of disease, risk factors, when to seek care
3. Culture
– how people think about health, disease and treatment
4. Demands of the healthcare and public health systems
– how to access care and services, payment, insurance
5. Demands of the context and particular situation
– stress, physical or mental impairment, unfamiliarity
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Health literacy is NOT the same as:
• Plain Language. Plain language is a technique for
communicating clearly. It is one tool for improving health
literacy.
• Cultural Competency. Cultural competency is the ability of
professionals to work cross-culturally. It can contribute to
health literacy by improving communication and building
trust.
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How is health literacy measured?
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Health literacy is a new component of the 2003 National
Assessment of Adult Literacy (NAAL).
– Nationally representative sample of more
than 19,000 adults aged 16 and older in the United States
– Assessment of English literacy using prose, document and
quantitative scales
Tasks used to measure health literacy were organized around
three domains:
– Clinical: Filling out a patient form
– Prevention: Following guidelines for age-appropriate
preventive health services
– Navigation of the healthcare system: Understanding what a
health insurance plan will pay for
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Health Literacy Levels
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Proficient: Can perform complex and challenging literacy
activities.
Intermediate: Can perform moderately challenging
literacy activities.
Basic: Can perform simple everyday literacy activities.
Below Basic: Can perform no more than the most simple
and concrete literacy activities.
Nonliterate in English: Unable to complete a minimum
number of screening tasks or could not be tested
because did not speak English or Spanish.
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Below Basic
0
Circle the date of a medical appointment on a
hospital appointment slip. (101)
Give two reasons a person should be tested
for a specific disease, based on information in
a clearly written pamphlet. (202)
Basic
Determine what time a person can take a
prescription medication, based on information
on the drug label that relates the timing of
medication to eating. (253)
Intermediate
Calculate an employee’s share of health
insurance costs for a year, using a table.
(382)
Proficient
500
Source: National Center for Education Statistics, Institute for Education Sciences
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Basic information about a colonoscopy, as perceived
by a patient with limited literacy skills
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Scope of the problem
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Percentage of Adults in Each
Health Literacy Level: 2003
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Source: National Center for Education Statistics, Institute for Education Sciences
Low health literacy is more
prevalent among:
–Older adults
–People with low income
–People with limited education
–Minority populations
–People with limited English
proficiency (LEP)
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IOM Report (2004)
Health Literacy: A Prescription to
End Confusion
“Nearly half of all American adults--90 million people--have
difficulty understanding and using health information, and
there is a higher rate of hospitalization and use of
emergency services among patients with limited health
literacy.”
Recommendations:
●develop and support programs to reduce the negative effects of limited
health literacy
●incorporate health knowledge and skills into the existing curricula of
kindergarten through 12th grade and adult education and community
programs.
●develop culturally and linguistically sensitve programs to promote health
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literacy and health education
According to the AMA:
– 21% of adult Americans are functionally illiterate,
meaning they read at 5th grade level or lower
– An additional 25% of adult Americans are marginally
literate
This translates to:
90 million patients with low health literacy
and
$73 billion dollars annually in extra healthcare costs
due to unnecessary doctor visits, hospitalizations and
longer hospital stays
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Why is health literacy important?
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Patients with limited health literacy
may have difficulty:
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Locating providers and services
Filling out health forms
Sharing medical history with provider
Seeking preventive health care
Managing chronic health conditions
Understanding directions on medication
Understanding and acting on health-related
news and information
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Low health literacy affects:
• Health outcomes
–medication errors
–increased doctor visits and
hospitalizations
• Healthcare costs
• Quality of care
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What can we do to help?
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Office of the Surgeon General
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Health literacy improvement is one of the
Surgeon General’s seven public health
priorities.
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“Health literacy is the currency of success for
everything I am doing as the Surgeon
General.”
—Dr. Richard Carmona in his speech to the AMA House of
Delegates, June 2003.
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Healthy People 2010 Health
Literacy Objectives
11-2. Improve the health literacy of persons
with inadequate or marginal literacy
skills.
11-6. Increase the proportion of persons
who report that their healthcare
providers have satisfactory
communication skills.
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In the patient visit
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Use plain language and listen carefully
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Use simple language and define technical terms – avoid
medical jargon
Use the active voice
Break down complex information into understandable
pieces
Organize information so the most important points come
first
Use a medically trained interpreter if necessary
Check for understanding using the “teach-back”
method
Ask open-ended questions
Use hand signals or visual cues
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Improve the Usability of Health
Forms and Instructions
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Revise forms to ensure clarity and simplicity.
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Test forms with intended users and revise as
needed.
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Provide forms in multiple languages.
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Offer assistance with completing forms and
scheduling followup care.
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The Health Education and
Adult Literacy Program
(HEAL)
Community Pediatrics at Columbia University and New York
Presbyterian Hospital in partnership with Community Health
Workers at Alianza Dominicana
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The HEAL program will improve the
health outcomes for parents and children
in the outpatient pediatric clinics.
Emphasis will be made upon the patients’ needs
in order to help them…
•Enhance their understanding in regards to medication use
•Increase their involvement in planning care
•Improve their adherence to medical instructions
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HEAL Program Goals and
Objectives
The HEAL program aims to decrease medication errors with
treatments prescribed by pediatricians by improving health
literacy in the population served.
We will develop, implement, and evaluate a culturally and
linguistically appropriate curriculum targeted to community
health workers, pediatric providers, and volunteers.
• Objective 1: To develop culturally responsive health education material
regarding medication adherence using the basic tenets of health literacy.
• Objective 2: To train pediatric providers and CHWs to appropriately address
low health literacy at different health care settings.
• Objective 3: Implement the HEAL curriculum in four pediatric outpatient
clinics in the Washington Heights/Inwood neighborhoods of Northern
Manhattan served by NYPH and at the various programs served by the
CHWI at Alianza Dominicana.
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Health Professional’s Role in
HEAL
• Identify patients with limited literacy levels
• Use simple language, short sentences and define technical
terms
• Empathize with cultural background, ethnic and racial
diversity of patients
• Provide information in patient’s primary language
• Offer assistance with the completion of forms
• Ask open/ended questions
• Use the “teach back method” to determine patient’s
comprehension
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Resources
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AHRQ Report—Literacy and Health Outcomes (2004):
www.ahrq.gov/clinic/epcsums/litsum.htm
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Healthy People 2010 (2000): www.healthypeople.gov
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Healthy People 2010 Health Literacy Action Plan—
Communicating Health: Priorities and Strategies for Progress
(2003): http://odphp.osophs.dhhs.gov/projects/healthcomm/
objective2.htm
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IOM Report—Health Literacy: A Prescription To End
Confusion (2004): www.iom.edu/report.asp?id=19723
NIH Improving Health Literacy Web page:
www.nih.gov/icd/od/ocpl/resources/improvinghealthliteracy.ht
m
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