Health Literacy: A Misunderstood Health Care Issue

Being able to understand what a healthcare professional is telling you about your diagnosis or treatment is imperative to have effective care. That involves understanding the extent of your disorder or disease and knowing the instructions to carry out treatment after the 15-minute appointment is over. Health literacy often plays into a medical professional’s ability to convey information in an understandable way; that is a skill that is learned and improved over time, but sometimes the patient just simply cannot understand the information presented to them. Health literacy applies to both oral information and written documentation.

Health literacy issues are most common in older adults and this is the age group that often has the most medical care and attention, so it might be easy to see where issues lie throughout the process. Globally, one in 10 adults has low health literacy. The Health Resources and Service Administration says, “A number of patients may be confused with certain medical language, have difficulty understanding English, struggle with filling out forms, or have limited access to health providers in their community” (Health Literacy). Being able to understand what is being said is essential from everything from regular care to well-informed consent. If not, there are legal issues that lie because the patient-physician contract might be considered null and void if the patient did not fully have the capacity or understand the health information.

Why might someone not understand the information? This is not necessarily discussing individuals that strictly do not have the mental capacity to make decisions for themselves, health literacy looks more at individuals that have a few barriers. Those barriers might be: “low educational skills, cultural barriers to health care, [or] Limited English Proficiency (LEP)” (Health Literacy). What might make a situation worse is if the health care provider uses words and phrases that a patient, mentally capable or not, does not understand.

There are a lot of dangers that come with the low health literacy of a patient. The most significant issue that arises with low health literacy is a higher chance of patient nonadherence to treatment and increases chances of unnecessary hospitalization and mortality. It might be obvious how one issue might cause another: if a patient is not using medications or following instructions correctly, it can get quite problematic.

There are a lot of ways for health care providers and their agents to not only identify individuals with low health literacy but also mitigate the chances for miscommunication and low understanding of information. When it comes to written documents with medical information on them one of the easiest and widely adopted methods is just making the layout easier to follow. Nature Reviews Cardiology says, “Simple strategies such as using a large bold font, bulleted lists, short sentences, avoiding long words and technical terms, and including basic diagrams and pictures can make the text more accessible. In addition, using personal, 'everyday language (for example, “we” to refer to the health-care provider, and “you” to refer to the patient), repeating important points, and explaining concepts in simple terms aids understanding” (King Poor health literacy: a 'hidden' risk factor). That method solves issues revolving around documents, but what about verbal instruction? It is difficult to change something on the patient's end so physicians and other health care personnel have to adapt. They have to be able to identify key things such as body language and blaming slight misunderstandings on irrelevant things. Once identified, it is the health care professional's duty to convey messages at an even slower pace without accidentally insulting the patient to where they feel inadequate.

Some suggest that screening for low health literacy is the solution. While that may seem like a good idea, someone will run into the problem of making the patient or patients feel insulted or inadequate. The BMJ's article over “Screening for health literacy is not the answer” says, “Screening for health literacy assumes that we have time not only for the test . . . but also a minute or two to decipher who needs the additional literacy interventions and another few minutes to implement those additional interventions. Rather than spending that time administering and scoring health literacy tests, we could spend it supporting all the patients through clear communications” (Kronzer). Not only would this cause a time issue for health care facilities, but the chances of insulting a patient rises. Imagine accidentally labeling someone to have low health literacy. Information like this would be recorded on the patient's Electronic Health Record and if the patient views that and sees a label like that, they will probably be upset.

The only way to help a patient with low health literacy orally is to just be able to identify an individual while talking with them and adapt the dialogue accordingly. Bringing awareness to an issue that affects so many is essential to continuously provide quality care.