Health Literacy

Points to Consider

The average American reads at the 8th to 9th grade level.

44% of people age 65 and older read at about the 5th grade level or lower.

48% to 80% of patients age 60 and older have inadequate functional health literacy.

 

Health literacy is the ability to "read, understand and act on healthcare information," or more specifically, "the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions."

 

Many studies have been conducted on health literacy. One study showed that about half of all American adults may have trouble reading important health related documents, such as patient education materials, consent documents and insurance forms because most of these documents are often written at a 10th grade level or higher.

Another study showed that:

42% of patients could not understand directions for taking medication on an empty stomach.

26% could not understand an appointment slip.

60% could not understand the standard consent form.

Elderly people, members of minority groups, immigrants and people with low incomes are likely to have problems with reading. For example, two thirds of adults age 60 and older have an adequate or marginal literacy skills, the median reading level for person receiving public assistance is fifth grade and 40% of blacks and 50% of Hispanics have reading difficulties. However, age, race, birthplace and income level are by no means reliable indicators of literacy or illiteracy.

Patients with low health literacy often have problems communicating with caregivers because, "providers did not listen to them or explain their medical problem and treatment in a way that they could understand." Due to feelings of shame about their illiteracy, low literate patients may be more intimidated by medical settings and hesitant to ask questions or to tell someone they don't understand. In interviews, these patients said that filling out forms and registering for care are the most difficult and embarrassing problems they contended with in healthcare settings and the situation was made worse by staff members who became angry or frustrated with them. Some patients even avoid seeking care rather than be embarrassed. People with low literacy skills often are uninformed or misinformed about health matters.

One patient stated, "If there could be a person that could talk like us, and be kinder, and asked us if we can read, or offer to fill out the papers, and with a smile, so we can feel the person supports us... but if we see their hard faces, how can we ask for help to fill out the forms?"

The most important things healthcare professionals can do to help patients with limited literacy are recognize how pervasive the problem is, be sensitive to the stigma and stress associated with reading difficulties and be quick to offer help tactically. For example, if the patient seems to be struggling with a form or handout, a staff member might say, "A lot of people have trouble filling out these forms or reading this information. Can I help you with it?" or, "Would you like me to read it to you and explain it?"

Most patients prefer to have both oral and written explanations. Information should be presented orally first, with written materials provided as a reminder. When you're providing information to patients orally, listen carefully to the patient's questions and concerns and create an atmosphere of trust and respect.