What do these patients have in common? They lack health literacy which is defined as the ability to obtain, process, and understand health information and services to make appropriate health decisions. (1)
Lack of health literacy costs the health care system billions of dollars per year. More importantly, it costs many millions of people their good health. Poor health literacy means decreased opportunity for preventive measures, increased chance of chronic illness, a decreased chance of effective treatment due to apparent non compliance on the part of the patient, longer hospital stays, and missed opportunities for medical benefits because citizens are unaware they qualify.
Who are the people with low health literacy? They are likely to be elderly, have little education, and are under or uninsured. They get little of what they know about health and health care from print sources, relying more on media, such as TV and radio. They also get some of their knowledge from friends, family, and health care professionals.
Approximately 35% of survey participants in the US Dept of Health National Assessment of Adult Literacy in 2003 scored at a basic or below basic level of health literacy.(2) In the below basic category a respondent was unable to recognize a hospital appointment on a hospital form or understand how often to have a medical test from a pamphlet. At the basic level a person would have difficulty in giving 2 reasons why a person with symptoms would have a medical test. In contrast the 12% of proficient health literate citizens were able to calculate the employee cost of health insurance for 1 year using a table that presented different scenarios for income and number of family members.
Health literacy requires the ability to understand medical terms and use numerical skills. For instance in one study participants were asked to read a cough syrup label. Those at the low end of the literacy sale were unable to read the instructions in case of overdose.(3) Numeracy skill is required if for example, a patient has been advised to reduce sodium levels by 50%. The patient would have to know the maximum recommended level of sodium and calculate 50%. Then the patient would have to read nutrition labels and be able to calculate the number of servings of particular foods of everything that contained sodium and add that up for the day. Those with basic or below basic health literacy skills would not be able to use this preventive measure without some guidance from someone with a higher literacy level.
For a desired outcome in health care encounters these components exist: Character of the action, the literacy level of the patient, and the appropriate level of the health care material presented to the patient. Health care professionals are becoming aware that the patient may be willing to be compliant but lack the skills to do so. Nor will patients admit their lack of understanding, instead they will try to compensate for their difficulty by procrastination or referring challenges to other family members.(I’ll let my spouse read it at home, or I forgot my glasses.)
What will increase the chance of successful medical care? In one on one care nurses can use less technical terms and more everyday plain language. They can also present the necessary information with a view to relating it to what the patient already knows. Patients are more likely to remember unfamiliar complex information if it is tied to what they have already experienced. For instance, in emphasizing the importance of Vitamin D, a nurse could say, ”Remember when you were a child your mother gave you cod liver oil every morning?”
Studies have also shown that the most important information should be presented first. Nurses should not present too much new information at once. Visual aids are also helpful. An interactive format where the patient can relay back in his or her own words what he or she has understood is effective. This is sometimes known as the teach back technique. Also the literacy level of patient cannot be gauged easily so no assumptions of skill should be made.
Nurses are in a unique and ideal position to increase the health literacy of many citizens. This is because they have the most interaction with patients and are responsible for the majority of patient education. Not only are nurses present at every stage of the health care process they practice in strategic locations throughout the community where health and illness intersect, such as schools, public clinics, nursing facilities, workplaces, and homes. Nurses are trusted and as such could be the most likely health professionals for the patient to confide in about their lack of health literacy. Nurses’ observational skills can help pinpoint patient difficulties to ensure a better outcome.
When Gloria Mayer, RN, noticed that the pamphlets that her organization was distributing were ending up in the wastebasket of the waiting room she knew that the information was not being used. She is now principal of the Institute for Health Advancement which holds an annual health literacy conference.
Nurses can advocate on an organizational level to increase health literacy. They can help redesign information on forms, pamphlets, and signs. Presently print information is produced by pharmaceutical companies at a grade level higher than most patients can understand. Nurses’ direct experience with patient care will mean print information will be relevant to their particular health care setting. They can initiate programs and policy changes and design innovations. There are tools that nurses can help implement such as the National Action Plan or the Health Literacy Universal Precaution toolkit from the AHRQ. The National Institute of Nursing Research is also involved in health literacy research. Research is needed in the areas of patient communication and care, disease management, health promotion, and cultural adaptation.
There is a growing awareness in health care systems that health literacy is a serious but often invisible problem where only the consequences are seen. No initiative to better the health of the nation will be successful without first addressing health literacy.
Policymakers and health systems are implementing change and nurses must be involved. Nurses will be the professionals who will create health information that is accurate and accessible to all in a shame free environment. The information and services will be patient centered, which will enable citizens to become lifelong learners for good health.
How is your health care center doing when it comes to improving healthcare literacy in patients?
- Sources:
(1)http://www.health.gov/communication/literacy/issuebrief/
(2) Ibid
(3) http://www.ama-assn.org/ama1/pub/upload/mm/367/hl_report_2008.pdf
http://www.iha4health.org/default.aspx?MenuItemID=351&MenuGroup=_Health+Literacy+Conference&&AspxAutoDetectCookieSupport=1
http://www.ahrq.gov/qual/literacy/
http://www.cdc.gov/HealthLiteracy/
Nursing Outlook, March/April 2011 Vol. 59 No 2
Profiles American Journal of Nursing March 2004 Volume 104 No. 3 p118-119
© MyNursingUniforms.com 2011
