Low Health Literacy: A Guide for Public Health Advocates

June 10, 2019

Health literacy is an evolving concern in the fields of public health and healthcare today.  It is important that we remind ourselves how it can impact quality of care and health outcomes for many Americans. Health literacy is defined as the extent to which an individual can obtain, process, and understand basic health information to utilize services and make appropriate health decisions. This blog post will focus on the impact of low health literacy on an individual’s health and steps health professionals can take to better advocate for individuals who struggle with low health literacy skills.

 

The impact of low health literacy

Low health literacy can affect an individual’s everyday life, impacting both their physical and mental health. Along with the potential for psychosocial stress and low self-esteem, studies find strong correlations between low health literacy and negative physical health outcomes. A commonly used example of low health literacy is not having the ability to read a pill bottle. This can lead to issues with dosage, adherence, medication interactions, and even taking the wrong medication. Health literacy can also influence an individual’s decision making in various settings. Strong positive associations have been identified between low health literacy and not receiving a seasonal influenza vaccine, increased hospitalization rates, worse metered dose inhaler techniques for asthma, and lower rates of preventive services like Pap smears and mammograms. In general, those with low health literacy skills are more likely to experience challenges accessing healthcare and healthcare services.

 

 

How to be an advocate

Improvements in health practice have the potential to address negative health outcomes that can stem from low health literacy. Keep in mind that those with low health literacy skills may be self-conscious when interacting with health professionals. You can be a better advocate for individuals with low health literacy skills by learning when to appropriately use these strategies and techniques:

  • Ask open-ended questions and informally gauge an individual’s comprehension of the information you provide.

  • Pay close attention to the diction and actions of everyone (including yourself) and avoid making assumptions about the depth of knowledge an individual has on any given health topic.

  • Speak clearly with a simplified vocabulary while still treating everyone in a manner that is respectful of their age.

  • Avoid lesser known abbreviations to health conditions, procedures, and government entities.

  • Give a clear summary of any consent form or important document, even if the individual requests to read it at a later time.

  • Legibly write down important information or highlight key parts of any document.

  • Suggest current programs and initiatives available through your local health department and provide specific details about what the programs can offer.

  • Ask the individual about their needs and if there is anything they would like to go over again.

  • If the topic of health literacy, or literacy in general, comes up in conversation, offer reassurance that many people have a difficult time understanding health information and that you, a health educator, can help.

  • If a formal assessment of an individual’s reading comprehension and numerical ability is required, the Functional Health Literacy in Adults (TOFHLA) test may be used.

  • The Rapid Estimate of Adult Literacy in Medicine (REALM) may also be used as a quick and valid assessment of an individual’s health literacy in a busy primary care or research setting.

  • For more information, follow the link below to an issue brief that strategizes ways to improve health communication and health literacy published by the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion: https://www.michigan.gov/documents/mdch/LiteracyHHSarticle_205541_7.pdf

 

While parts of this list may seem intuitive, perhaps the most salient point is to not dramatize the situation. In other words, subtly do what you can to bypass barriers and support individuals as much as possible without making them feel marginalized. Through the implementation of these strategies and the constant practice of empathy, we can better inform and assist individuals with low health literacy skills to ultimately improve their well-being and the public’s health.

 

References

Brez, S. M., & Taylor, M. (1997). Assessing literacy for patient teaching: perspectives of adults with low literacy skills. Journal of Advanced Nursing, 25(5), 1040–1047. https://doi.org/10.1046/j.1365-2648.1997.19970251040.x

 

Davis, T. C., Wolf, M. S., Bass, P. F., Thompson, J. A., Tilson, H. H., Neuberger, M., & Parker, R. M. (2006). Literacy and Misunderstanding Prescription Drug Labels. Annals of Internal Medicine, 145(12), 887. https://doi.org/10.7326/0003-4819-145-12-200612190-00144

 

Dewalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N., & Pignone, M. P. (2004). Literacy and health outcomes: a systematic review of the literature. Journal of general internal medicine, 19(12), 1228-39.

 

Illiterate individuals are here among us! |Literacy Foundation. (n.d.). Retrieved February 19, 2019, from https://www.fondationalphabetisation.org/en/causes-of-illiteracy/illiterate-individuals-are-here-among-us/

 

It’s Health Literacy Month – Be a Health Literacy Hero! – Becker Medical Library. (2016). Retrieved April 11, 2019, from https://becker.wustl.edu/news/its-health-literacy-month-be-health-literacy-hero/

 

NHLBI Clinical Trials | National Heart, Lung, and Blood Institute (NHLBI). (n.d.). Retrieved February 21, 2019, from https://www.nhlbi.nih.gov/health-topics/clinical-trials/nhlbi-clinical-trials

 

U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy.

 

Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.

 

Weir E. (2001). Illiteracy as a public health issue. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 164(10), 1486.

 

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