As technology has improved and more electronic health record data has been collected, researchers have come to better understand one key predictor of patient health outcomes – health literacy. Health literacy is an emerging field of study defined as a patient’s ability to assess and comprehend health information and services to make informed decisions.
Poor health literacy can affect how a person reads medical labels on pill bottles and takes medications, how they interact with a doctor, or how they react to other health-related challenges. According to the U.S. Department of Health & Human Services, more than 77 million adults in the United States have basic or worse health literacy skills.
Low health literacy can lead to unnecessary hospital readmission, medication errors, rising healthcare costs and diminished patient satisfaction.
The Effects of Culture on Health Literacy
A diverse population – encompassing language and cultural backgrounds – presents potential challenges for nurses and healthcare organizations aiming to improve health literacy. While a patient who does not speak English being treated in the U.S. can face obstacles, cultural barriers might also influence health literacy.
Before patients enter a healthcare facility, their cultural context has informed the way they think about their health, and the way they discuss it. Culture can impede health literacy by building barriers or fostering misunderstanding as patients and healthcare providers communicate.
Although many healthcare organizations offer translators to mitigate culture’s potential effect on health literacy, navigating health conversations can pose challenges even in the patient’s native language. Healthcare is rife with jargon and often requires context, which might not translate well even with the help of an interpreter.
The Impact of Poor Health Literacy
In its 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers, the Kaiser Family Foundation reported three out of every four healthcare consumers sought help because they didn’t understand the Affordable Care Act – or their own health insurance.
This uncertainty suggests that navigating the web of insurance and healthcare language has become so complex that most Americans are no longer equipped with the knowledge to do so. Health literacy challenges might cause a population to have less preventive care, lowering quality of life and increasing medical expenses.
At an individual level, poor health literacy often means poor quality of health. About 23% of the sick population measured a poor health literacy compared to 16% among the healthy, according to a research paper in the Geriatric Nursing Journal titled “The Impact of Inadequate Health Literacy on Patient Satisfaction, Healthcare Utilization, and Expenditures Among Older Adults.” With low health literacy, people with chronic conditions struggle to understand their illness and manage it.
A Journal of General Internal Medicine report titled “Health Literacy and the Risk of Hospital Admission” found low health literacy is disproportionally present among an older, less-educated population. This poses challenges, given that an older population is more likely to suffer from chronic conditions that would benefit from health literacy.
According to an editorial in Nature Reviews Cardiology Journal, most health literature requires at least an 11th-grade reading level to understand information about a condition, hospital discharge instructions, patient-consent forms and medication bottles. The post’s author reports that low health literacy can lead to unhealthy patient outcomes, high healthcare costs and an increased risk of hospitalization and death.
People with low health literacy are generally more likely to forgo preventative measures including flu shots, mammograms and other early-detection screenings. This translates to more emergency services through the ER and hospitalization, which are costlier.
Strategies for Improvement
Organizations, physicians, nurses and other healthcare professionals can take simple, practical steps toward improving health literacy by adjusting daily practices and advocating for system changes.
- Instruct patients to repeat the information presented in their own words, as a means to measure their comprehension (the teach-back method)
- Ask open-ended questions to evaluate how well the patient comprehends written materials, from prescription labels to discharge papers
- Demonstrate how to use a device or perform a task
- Present material upside down, and note if a patient turns it the correct way
- Eliminate jargon and use clear, simple language
- Replace lengthy written instructions with clear images, graphics and charts
- Alleviate pressure to appear knowledgeable by implying that questions are normal and expected
- Develop cross-cultural materials, and partner with other healthcare professionals working with low health literacy populations
Likewise, healthcare organizations can:
- Improve access to information online, leveraging apps and gamification to create fun, informative platforms for patients to learn
- Partner with insurers to create user-friendly healthcare comparisons – sites that easily and clearly allow consumers to truly compare the different kinds of insurance coverage available to them
- Review medical records to eliminate redundancies, such as a single medication listed under multiple names
- Provide education for nursing students and practicing nurses to understand how language and culture impact health literacy
Though the consequences of poor health literacy are substantial, a growing understanding of health communication and unprecedented access to digital information can, through education and behavior change, begin to improve health literacy among the population.