Health Literacy

HEALTH LITERACY

What You Need To Know and
What You Can Do About It

Objectives

At the end of this presentation, you will be able to:

1. Demonstrate a basic understanding of key health literacy concepts.
2. Communicate the importance of health literacy to colleagues, grantees, and contractors.
3. Identify specific ways to integrate health literacy into your work.

Overview

• What is health literacy and why is it important?
• Health literacy at HHS
• Strategies for improving health literacy
• Integrating health literacy into your work
• Resources

HEALTH LITERACY

What Is Health Literacy and Why Is It Important?

What Is Health Literacy?

Video clips of patients discussing their health literacy experiences. Patients describe in their own words their difficulties reading medication labels, understanding informed consent forms, and following a drug regimen. In the words of one patient, "It's just a language that I'm not familiar with." The video is produced by the Academy of Educational Development in collaboration with the Institute of Medicine with special thanks to the American Medical Association Foundation and the National Center for the Study of Adult Learning and Literacy.

What Is Health Literacy?

• 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.
• Health literacy is dependent on both individual and systemic factors
  1. Communication skills of lay people and professionals
  2. Knowledge of lay people and professionals of health topics
  3. Culture
  4. Demands of the healthcare and public health systems
  5. Demands of the situation/context

What Factors Affect Health Literacy?

1. Health literacy is dependent on the communication skills of lay people and health professionals.

• Communication skills include literacy skills (e.g., reading, writing, numeracy), oral communication skills, and comprehension.
• Communication skills are context specific.

What Factors Affect Health Literacy?

2. Health literacy is dependent on lay person and professional knowledge of various health topics.

• People with limited or inaccurate knowledge about the body and the causes of disease may not:
  • Understand the relationship between lifestyle factors (such as diet and exercise) and health outcomes
  • Recognize when they need to seek care
• Health information can overwhelm people with advanced literacy skills.

What Factors Affect Health Literacy?

3. Health literacy is dependent on culture.

Culture affects:

• How people communicate and understand health information
• How people think and feel about their health
• When and from whom people seek care
• How people respond to recommendations for lifestyle change and treatment

What Factors Affect Health Literacy?

4. Health literacy is dependent on the demands of the healthcare and public health systems.

• Individuals need to read, understand, and complete many kinds of forms in order to receive treatment and payment reimbursement.
• Individuals need to know about the various types of health professionals and services as well as how to access care.

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What Factors Affect Health Literacy?

5. Health literacy is dependent on the demands of the situation/context.

• Health contexts are unusual compared to other contexts because of an underlying stress or fear factor.
• Healthcare contexts may involve unique conditions such as physical or mental impairment due to illness.
• Health situations are often new, unfamiliar, and intimidating.

What health literacy is NOT…

Health literacy is NOT…

• 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.

Why Is Health Literacy Important?

Health literacy is important because it affects people's ability to:

• Navigate the healthcare system, including locating providers and services and filling out forms
• Share personal and health information with providers
• Engage in self-care and chronic disease management
• Adopt health-promoting behaviors, such as exercising and eating a healthy diet
• Act on health-related news and announcements

These intermediate outcomes impact:

• Health outcomes
• Healthcare costs
• Quality of care

Health Literacy and Health Outcomes

• Persons with limited health literacy skills have:
  • Higher utilization of treatment services
    • Hospitalization
    • Emergency services
  • Lower utilization of preventive services
• Higher utilization of treatment services results in higher healthcare costs.

Health Literacy and Quality of Care

Health literacy affects the quality of health care.

"Good quality means providing patients with appropriate services, in a technically competent manner, with good communication, shared decisionmaking, and cultural sensitivity."*

* From IOM. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001.

Health Literacy and Shame

• People with limited health literacy often report feeling a sense of shame about their skill level.
• Individuals with poor literacy skills are often uncomfortable about being unable to read well, and they develop strategies to compensate.

Measuring Health Literacy

• 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

Measuring Health Literacy

• 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 service
  • Navigation of the healthcare system: Understanding what a health insurance plan will pay for

Measuring Health Literacy

• 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.

Percentage of Adults in Each Literacy Level: 2003

Source: National Center for Education Statistics, Institute for Education Sciences