In 1992 and 2003, the U.S. Department of Education conducted a national assessment of adult literacy. The purpose of the assessment was to determine not only adults’ ability to read, but also how they apply printed and written information to daily life in home, work, and community settings. The assessment focused on three types of literacy skills: prose, which is continuous text (example: a newspaper article); document which is non-continuous text (example: a job application); and quantitative which are skills involving numbers (example: balancing a checkbook).
All three types of literacy skills are important to possess in order to manage one’s health. The ability to accurately complete insurance forms, understand the directions on a medication container, or follow discharge instructions after a visit to a hospital or urgent care center are a few examples of how literacy impacts an individual’s health status. The 2003 adult literacy assessment included situations such as these to specifically measure health literacy. The term “health literacy” was first used in the 1970’s, and refers to an individual’s ability to access and interpret health information which then can be used to make health care decisions.
The Journal of the American Medical Association called health literacy “the strongest predictor of health status” (1999). In addition, while medical care is becoming more complicated, the trend in health care is for people to accept more responsibility for their own care. Therefore, health literacy is especially important for seniors, since as people age, they are more likely to experience one or more chronic health conditions which require active management. Unfortunately, in the sixty-five and older age bracket, only 3% scored in the proficient category of health literacy, while 59% scored in the basic or below basic categories. Overall, older adults scored the lowest of any age group on this portion of the assessment.
Older adults are not the only population at risk for low health literacy. People living below the poverty line, cultural and ethnic minorities, people who speak English as a second language (even if they are fluent), and people with less than a 12th grade education are also at risk. Differences in how these groups of people process and understand health information is a primary component of health literacy, but another component which must be considered is how and why people obtain information and then use the information to make decisions.
There are a number of signs which can indicate low health literacy. When people are having difficulty obtaining information, understanding it, and/or applying it, they are more likely to report that their health is poor and verbalize frustration with their health care providers. They are less likely to use preventative services and may have periodic or frequent hospital admissions or visits to the emergency department. People with low health literacy may also have difficulty following a medication regimen and demonstrate poor management of their chronic health conditions.
Health literacy involves more than just an individual’s ability to read. When your doctor tried to explain the results of a test at your last office visit, how much of the explanation did you recall after leaving the office? Have you ever had to take a medication where the individual pills didn’t come in the exact dose that you were supposed to take? (This is especially true with the blood thinner Warfarin). Have you tried to research a new diagnosis or set of symptoms on the internet, and discovered confusing or conflicting information? Health literacy has an impact on the outcome of each of these situations. Future articles will address the multitude of factors which comprise health literacy, as well as steps which can be taken to strengthen health literacy. Stronger health literacy can lead to better health, and health care providers as well as individuals can implement strategies to work toward this goal.
Karen Kaslow, RN, BSN