Health Literacy

Health literacy is a social determinant of health that has a major impact on well-being and quality of life. Unfortunately, only 12% of Americans have adequate literacy skills to manage routine health-related tasks. Those with limited health literacy skills may not be able to understand how to correctly take medications or complete patient forms. Even patients with intermediate health literacy skills may have difficulty with numeracy activities, like reading graphs or calculating insurance costs. 
 
There are two types of health literacy:

• Personal health literacy: The degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
• Organizational health literacy: The degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. 

Health literacy is essential to good healthcare outcomes. Patients with limited health literacy may have difficulty adhering to treatment plans and appropriately using healthcare facilities and services. The negative outcomes attributed to limited health literacy levels include: 

• Making more errors when taking medicine.
• Receiving fewer preventive services.
• Using more inpatient and emergency department care services.
• Encountering higher healthcare costs and decreased health status. 

Limited health literacy can also lead to claims. Medication errors rank among the most common types of medical professional liability claims. The failure to undergo recommended preventive services, such as a mammogram or colonoscopy, can lead to diagnostic accuracy claims, especially when a patient presents with a sign or symptom such as a breast lump or rectal bleeding. Failure to diagnose breast and colon cancer are among the most common diagnostic accuracy claims. 

In some situations, the implications of misunderstanding health information are especially significant. People in these situations may be more likely to experience serious or life-threatening outcomes, a decline in their overall health, unplanned hospital readmissions, or discharge to inappropriate settings. While any health situation can become high risk, some are inherently riskier, like those involving stress and anxiety, disruptions in care routines, communication challenges, or more complex and high-stakes decisions like end-of-life planning. Common high-risk health situations include:

• Advanced care planning.
• Care transitions.
• Informed consent.
• Medication management. 

Poor care transitions and lack of informed consent are also commonly identified issues in medical liability claims. Care transitions are ineffective when a patient does not understand where to go next or why they must go there in the first place. Informed consent forms are often written at the college level by postgraduate professionals, such as lawyers and doctors. These forms are often difficult for even the most seasoned readers with strong literacy skills to comprehend. Communicating risks and benefits in a way that all patients can understand is key for making informed decisions. 
 

Risk Recommendations

Consider the following when evaluating your organization’s strategy to address health literacy challenges in the communities you serve: 

• Recognize red flags. Patients with limited health literacy may feel shame and try to disguise or hide the struggles they have in understanding the information that they are provided. As a result, health literacy concerns may not be easy to identify. Be alert for signs of limited health literacy such as failure to complete medical forms, missing appointments, difficulty discussing health concerns or medication regimens, skipping recommended tests, or failing to follow up on referrals.
• Implement universal precautions. Improve organizational health literacy and make health information easier to understand and access for all patients, not just those with demonstrated limitation in health literacy. Implement universal precautions for health literacy designed to simplify communication, streamline processes, and provide needed support.
• Simplify communication. Use plain language in all patient-facing communications regardless of whether you’re communicating verbally or in writing. Be sure that patients and/or their caregivers understand the information being discussed and their responsibilities by using the teach-back method with ALL patients. Ask patients directly about health literacy in a non-stigmatizing fashion and connect them with community resources as appropriate.
• Make the health system easier to navigate. The healthcare system comprises interconnected systems, advanced technology, and a “language” that is foreign to most. It can be difficult to navigate, even for the savviest of consumers. Make the healthcare system and office practice environment easier for patients to navigate by simplifying the referral process, making medications easier to access, and connecting patients to needed community and social support services.
• Create a welcoming environment. Patients with low or limited health literacy levels may be afraid to ask questions for fear of seeming ignorant or argumentative. Schedule enough time for encounters to avoid the appearance of being rushed. Maintain eye contact and position yourself at eye level when talking to the patient. Anticipate and encourage patient questions by posing your own open-ended questions, such as “What questions do you have?”
• Improve organizational health literacy. Be familiar with the attributes of health literate organizations, and ensure leadership makes health literacy integral to organizational mission, structure, and operations. Integrate health literacy into planning, evaluation measures, patient safety, and quality improvement. Train the healthcare team to be health literate and monitor progress. Involve patients in the design, implementation, and evaluation of health information and services, and strive to meet the patient population’s health literacy needs with a wide range of literacy skills and resources.
• Address personal health literacy. Use health literacy strategies in interpersonal communications and confirm patient understanding. Design and distribute print, audiovisual, and social media content that is easy to understand and act upon. Provide easy access to health information, services, and navigation assistance. Identify high-risk situations that require more attention to health literacy and implement strategies to prevent miscommunication. To the extent you are able, discuss insurance coverage and the costs associated with treatment.

Improving health literacy makes health information not only easier to understand but more accessible to patients. A comprehensive approach to addressing your organization’s health literacy challenges can enhance patient well-being, reduce costs, improve outcomes, and prevent claims.