A Growing Health Literacy Crisis

Do you have a health literacy deficiency? If you have any of the following symptoms, your health literacy could be low, and you could be at risk for serious health consequences:

You aren't sure you should ask questions about your care.

You don’t understand the medical terms in the materials you get from your doctor.

When your healthcare provider talks to you, you don’t understand.

If you have to perform arithmetic, you have trouble taking medications correctly.

You don’t know how to deal with healthcare providers and insurance companies.

You don’t understand forms you are signing at healthcare facilities.

If one or more of the above statements apply to you, you may have low or limited health literacy; you also have a lot of company.

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Only 12 percent of Americans have the health literacy skills that will allow them to effectively find their way through the health care system.

A scientific statement in the The American Heart Association (AHA) journal, Circulation, describes the dangerous impact limited health literacy can have on heart health and how it can reduce patients' ability to benefit from treatments for heart attacks, heart failure, stroke and vascular disease. The statement encourages healthcare providers to change the way they practice medicine in order to make it easier for all patients to get the care they need.

“The opportunities for communication failure by healthcare providers who treat people for heart disease risk factors, heart diseases and strokes are rampant,” said Jared W. Magnani, of the University of Pittsburgh School of Medicine and the chairman of the committee that wrote the scientific statement, in a press release. “Many patients do not understand the written materials they receive as part of health care or do not have the numeric skills to understand quantitative information. Also, medical care uses a considerable amount of specialized terminology, which some call jargon.”

Researchers reviewed studies on health literacy published over a 12-year period and found examples of the kind of impact of low health literacy, can have:

Over half of those with low health literacy did not realize that a blood pressure reading of 160/100 mm Hg was not normal, making it two to three times less likely that those with high blood pressure would get it under control.

Dependence on nicotine is more common in people with low health literacy, and they are three times more likely to fall back on nicotine after completing a smoking cessation program.

The combination of a diagnosis of diabetes and low health literacy makes it more likely that people with the disease will develop one of the many chronic complications of diabetes, and they are much less likely to use an online patient portal for communication and disease management.

Parents whose health literacy is low are twice as likely to believe their overweight child’s weight is normal.

Patients with low health literacy may not understand that a “positive” stress test is not a good result.

Patients who are instructed to follow a low sodium diet may not know how to identify sources of sodium in a list of ingredients, much less interpret nutrition labels.

Low health literacy is more common among people who are older, those whose doctors do not speak their native language, and people with less education and economic stability, including racial and ethnic minorities. But even people with higher education may not be familiar with medical jargon when faced with a diagnosis or situation beyond their normal scope of medical experiences.

Health literacy is not a patient problem, it is the result of a complex healthcare delivery system.

Only 12 percent of Americans have the health literacy skills that will allow them to effectively find their way through the complicated health care system, and the AHA believes that limited health literacy will only get worse with time.

Technological and pharmacologic advances in health care, including the use of monitors to report heart status, other mobile heath initiatives, and a growing emphasis on shared decision-making and patient-reported outcomes won’t benefit those with the greatest health needs if health literacy isn’t addressed, Dr. Magnana believes.

Low health literacy is not a patient problem; the statement makes clear that it is the result of a healthcare delivery system that has become increasingly complex. Healthcare providers can ease the situation by improving the way they communicate with and treat their patients, making sure their patients fully understand their diagnosis and treatments.

The American Heart Association offers healthcare providers the following tips to combat low health literacy:

Avoid using medical terminology. Use words patients can understand.

Use pictures as teaching tools.

Create forms, informed consents and reading materials that use words that are understandable to patients.

Improve patient follow-up and phone communication, training office staff to speak simply and clearly.

Ask patients to bring in all medicine bottles so medication use can be assessed for adherence and safety.

Take into consideration patients’ culture, customs and beliefs.

Provide patients with support from specialists as well as case management and community resources.

Health literacy is not about how well you can read. It’s about how well you understand the information about your health your healthcare provider gives you. If you don’t understand, don’t be afraid to ask, and don’t be afraid to ask questions and give your doctor ideas for ways he or she can help you understand. Medicine is often complex. Your doctor has to pay attention to advances in their field and translate that information into advice for patients; your questions can make this part of their job a little easier.