Health Literacy

NewWays Learning: Literacy and the Well Being of Our Community

Chicago Humanities Festival October 24, 2010

The National Literacy Act of 1991 defined General Literacy

as an individual’s ability to read, write and speak in English,
compute and solve problems at levels of proficiency necessary
to function on the job and in society, to achieve one’s goals and
develop one’s knowledge and potential.

The National Institute of Health defines Health Literacy

as the degree to which individuals have the capacity to obtain,
process, and understand basic health information and services
needed to make appropriate health decisions.

The National Assessment of Adult Literacy shows that
of adults 16 and older in the United States:

22% have Below Basic skills: They can only perform the most simple and concrete literacy skills

29% have Basic skills: They can only perform simple and everyday literacy activities

44% have Intermediate skills: They can perform moderately challenging literacy activities

Only 13% have Proficient literacy: They can perform complex and challenging literacy activities

In Chicago 53% of adults have limited literacy skills.

20% read at or below the 5th grade level

50% of those receiving public assistance did
not graduate from high school and do not have a GED.

70% of those incarcerated lack a high school diploma or GED.

28.2% have less than a high school education

12.4% have only an elementary education

Only 52% of High School students graduated in 2006.

Of those who entered Chicago City Colleges:

69% were not prepared for college level reading
79% were not prepared for writing,
95% were not prepared for math.

Low levels of education are linked to high levels of poverty.

36% of job applicants lack the needed reading and math skills.
Adults with limited literacy skills earn 42% less than high school graduates.
1 in 4 U.S. working families is low-income, 1 in 5 children lives in poverty.
Parents and caregivers in many of these households may lack the
education and skills to earn a Family-sustaining wage.

Low literacy and poverty lead to serious health problems.
Literacy is said to be the single best predictor of health status,
more than age, income, employment status or racial and ethnic
group. Being unemployed or under-employed often means no
health care including preventive care and the ability to live a healthy
lifestyle. Healthy food is expensive.

Poor neighborhoods are food deserts without affordable healthy
grocery stores. Poor children go to school hungry or with bad
nutrition and are unable to focus leading to academic failure.

61% of low-income families do not have books in their home for
their children. Only 7% of poor children can recognize all the letters of the alphabet. This leads to a generational circle of poor health, poverty and illiteracy.

All this means that more than 50% of the people who walk into a medical office, clinic or hospital are at risk of not comprehending what is said or what they are reading, making mistakes, having excess hospitalizations, possibly being misdiagnosed and having poor health outcomes. Low Health Literacy equals Problems with medications, appointment slips, informed consents, discharge instructions, health education materials, and insurance applications.

Low literacy can mean low critical thinking skills and not understanding the steps of instruction and problem solving. Healthcare professionals need to keep this in mind when asking people to use equipment, work on a computer, know what to do in an emergency, or to understand and answer questions from a doctor.

People with low literacy struggle every day with…

Reading mail or a brochure on diabetes or safe sex

Using the bus, the train, or finding their way in a hospital

Recognizing the name of a doctor or teacher

Filing out tax forms, applications, or a medical form

Following directions on a map,

Reading instructions or medication labels

Helping their child with homework

Health literacy is not only a patient’s literacy skills. It is also the complexity of everything involved in the health care system. Today we have more medications, tests, procedures and growing self-care requirements.

Health literacy is the demands placed on people by their condition, the language of the medical culture, and a health care system that often assumes health literacy and often requires people to find their own health care solutions.

Poor health literacy has profound financial consequences on the health care system.

People with low functional health literacy have higher health care costs.

They are more likely to receive health care from publicly financed programs or walk into an emergency room as their only and last resort for care.

Emergency room patients with low literacy are twice as likely to be hospitalized.

From 2006 -2007 the percent of adults, age 18 to 65, reporting their health status as “fair or poor” was highest among high school dropouts (20%) and lowest among those with a bachelor’s degree or higher (4 to 5%).

75% of Americans who reported having a long-term illness (six months or more) had limited literacy.

Low level readers will not always let us know of their low skills and often hide their literacy challenges. This leads to patient materials that are too difficult and people not understanding the information needed to live a healthy lifestyle.

Patients with limited reading ability may feel ashamed, embarrassed, anxious, and even angry.

They will protect themselves in Health Care Settings.

They may bring someone who can read

Watch other people and do what they do

Pretend they can read

Use humor and let the doctor or nurse miss the concern

Make excuses, be demanding, ask other patients

Never ask for help or seek help only when illness is advanced

They may be quiet, passive or just walk out of the waiting room

How to Improve Health Literacy: We need Patient-Centered Visits
where healthcare professionals engage in a dialogue with patients
and encourage questions in a shame-free environment.

We need to use “Teach Back” Techniques, having patients
demonstrate understanding. Asking, “Do you understand?”
does not encourage dialogue but only one-word answers.

Just because a patient can recognize all the words or can answer questions
does not mean they have comprehension. It is possible to answer
questions correctly even if you do not understand the meaning
of the text or what is being said. For example:

Jhon bought a pooter at the hardware store. He needed a Pooter for his tright. A tright won’t doop if it doesn’t have a good pooter.

What did Jhon buy? What did he need it for? What would happen if he did not but it?

Healthcare professionals must explain things clearly using plain everyday Language:

No medical jargon. Define new words, use words with a single meaning and focus on key points.

Be alert for “red flags” like excuses and paperwork difficulties.

Medication reviews can also identify and address problems.

Include patient’s families, be aware of cultural issues, and
provide a reader or language interpreter if needed.

Ask patients how they prefer to get information.

Make sure assistance is confidential.

Give patients easy-to-follow instructions and
be sure there is a follow-up call.

We also need to be aware of individual Learning Styles.
People differ in which of the five senses they depend on most when
learning and in what kind of environment helps them learn the most.

Health information materials should be short, direct, clear simple everyday plain language with visuals to explain important information. No abbreviations, contractions, and acronyms that make documents confusing and hard to read.

It has always been my own approach that “less is more”. I have never heard anyone say, “this brochure is too simple and easy to read, do you have anything more complicated or at a higher grade level.”

Literacy is an essential part of the health and well-being of our community. Healthcare professionals must be sure, that the community and the patients whose lives we seek to improve truly understand what is said and done and what their choices are.

True informed consent is the result of a process of communication. It is a caring conversation between a patient and their doctor that should results in the patient’s total understanding of the situation.

A patient/learner centered dialogue and Patient-Friendly Educational Materials will enhance Interaction, it will ensure informed consent and it will ensure the health and vitality of our community.