Healthcare literacy is defined as “the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment.” A recent government study estimates that over 89 million American adults have limited health literacy skills. Studies also show that people of all ages, races, income and education levels are challenged by this problem. Individuals with limited health literacy are at great risk, evidenced by data showing they incur medical expenses that are up to four times greater than patients with adequate literacy skills. Besides the impact on individual well-being, health illiteracy costs the healthcare system billions of dollars every year in avoidable doctor visits and hospital stays. Compounding the problem is the fact that most patients hide their confusion from their doctors because they are too ashamed and intimidated to ask for help.
Leading experts in patient safety agree that there is an important connection between health literacy, healthcare quality and patient safety. Research suggests that people with low health literacy:
- Are less likely to take medications correctly
- Are less likely to comply with treatments
- Lack the skills needed to successfully navigate the healthcare system
- Are at a higher risk for hospitalization
- Principles to remember in handling this responsibility
According to the American Medical Association, “poor health literacy is a stronger predictor of a person’s health than age, income, employment status, educational level and race.” Populations most likely to experience low health literacy are older adults, racial and ethnic minorities, people with less than a high school degree or GED certificate, people with low income levels, non-native speakers of English and people with compromised health status. Education, language, culture, access to resources and age are all factors that affect a person’s health literacy skills.
Special consideration should be given to patients with:
- Cognitive challenges and impairments
- Visual impairments
- Hearing impairments
- Chronic disease
- Multiple prescribed medications
- Low English Proficiency (LEP)
Health Literacy Laws/Regulation/Requirements
CMS and the Office for Civil Rights regulations, along with The Joint Commission’s Standards, underscore the fundamental right and need for patients to receive information about their care, both oral and written, in a way they can understand in order to make informed treatment decisions.
Practical Tips for Success in Handling this Responsibility
The primary responsibility for improving health literacy lies with health professionals and healthcare and public health systems. Healthcare professionals must work together to ensure that health information and services can be understood and used by patients. To do this, healthcare professionals should:
- Offer training on diversity and the basic principles of healthcare literacy to medical staff and clinicians.
- Create a safe environment where patients feel comfortable asking questions.
- Use plain language instead of medical jargon.
- Use clear language in communications between caregivers and the patient.
- Sit down when speaking to patients instead of standing, so you will be at eye level with them.
- Use visual models or simple drawings to illustrate a point or technique.
- Ask patients to “repeat or teach back” the instructions or information you have given them and limit interruptions during teaching as much as possible.
- Describe the “teach-back” process as a way to test whether you were as clear as you meant to be. Avoid any language (e.g. “Did you get that?” or “Did you understand me?”) that implies you are testing the patient’s or family’s ability or education level.
- Be sensitive to your individual patient’s needs.
- Ask open-ended questions that imply a desire to understand the patient, not judge the patient. It’s OK to ask, “Do you have any special food requirements related to your culture or religion?” It’s not OK to say, “I heard people from your background have some odd dietary rules.”
- Admit your own lack of knowledge, both because it helps you learn and it makes the patient more comfortable to realize education can go both ways. Don’t be embarrassed to say, “I haven’t traveled as much as I’d like, so I’m afraid I don’t know much about Sri Lanka. Tell me something I should know about what it’s like there.” But realize that it isn’t very helpful and could sound a bit dismissive to say, “Wow, Sri Lanka; you’re a long way from home.” The goal is to engage your patient in effective care, which involves building rapport, trust and mutual respect.
- Inventory your work area and educational materials and begin identifying ways that you can improve communication with your patients by being sensitive to health literacy issues.
- If a patient has Limited English Proficiency (LEP), enlist the services of a qualified interpreter. Do not rely on family members to interpret for any significant interchanges related to health assessments, treatment plans or discharge arrangements.
- Recognize that cultural backgrounds influence people’s approach to essentially every aspect of their care, so pay attention to matters like which family member the patient wants to know things, who has influence over the patient (to help engage the patient in therapy activities, for example) and how the patient’s philosophical or religious views toward aging and disability might affect treatment choices and communication styles.
- Be aware that your own background and experience give you a particular cultural perspective; never assume that your view is “correct” or “standard” and that other views are the ones that require cultural sensitivity.
- Be quick to ask about a patient’s preferences both for communication (e.g. Would you like to talk about this, or would you like me to write it down?) and for cultural practices (e.g. I notice you have some religious articles by your bed. Is there a way we can we help you keep up the practices that are meaningful to you?). Honoring individuals’ choices and values is a key way to show respect, whether or not you are familiar with or share those values.