Health literacy is the ability to obtain, interpret, and apply information to maximize personal wellness. Improvements in health literacy can lead to better health for any individual. The first step toward making these improvements is an understanding (by both individuals and health care providers) of the factors which affect health literacy. To a certain extent, one’s level of health literacy is dependent upon educational skills such as reading, math, listening, comprehension, and critical thinking/analysis. But there are also personal, cultural and environmental influences which will have an impact on the successful communication and understanding of health information. A closer look at the obstacles will demonstrate how better outcomes can be achieved by changing our current approach to health literacy.
An initial step toward improving health literacy is consideration of the subject material in relation to the personal and cultural background of the intended audience members. Is information wanted and what are the expectations? Is the information relevant for them and do they comprehend how and why it is relevant? The motivations of the learner will greatly impact the quality of attention which is given to the information. Prior knowledge and experience regarding the subject, religious and cultural beliefs/ health practices, the availability of social supports to assist with learning and reinforcement of the information, and financial considerations are additional factors which will influence the willingness to learn, acceptance of the information, and application of the information.
For example, the educational needs of two people who are at risk for heart disease are much different if one individual was raised on southern fried food and the other eats healthy foods but has a sedentary job. Teaching about the benefits of a certain medication in the management of a disease may be lost on someone whose family member experienced terrible side effects from the same medication, or if paying for the medication is a concern. Finally, how does one handle learning to inject insulin if there is a fear of needles? In all of these situations, a personalized approach to sharing health information can be effective in identifying potential stumbling blocks for the learner so that adjustments to education and a treatment/care plan can be made sooner, resulting in improvements in overall health.
The educational skills, cognitive abilities, and preferred learning style of the audience also must be accounted for when preparing and presenting health information by verbal instruction or in written format. Vocabulary is a major element in these areas, since the practice of medicine has a language all its own. Do you know what a doctor is talking about if he tells you that you had a myocardial infarction? If you fracture your humerus, where is that? Have you ever looked at a written prescription which contained abbreviations like p.r.n. or b.i.d.? When health professionals are sharing information, they must be careful to use terms that will be understood by the general public. If you are on the receiving end of health information, don’t be afraid to ask your provider about language that you don’t understand. It is difficult to follow instructions or make informed decisions if you are unable to fully comprehend what you have read or been told.
In addition to vocabulary, listening to and reading health information will also be impacted by sentence structure and length, and the organization of the information. Information which is divided into short sections and presented in a logical order is more likely to be understood and retained. Listening skills may be affected by the speaker’s tone of voice and accent, and how slowly or quickly the speaker talks. Reading skills may not only involve words but also the ability to interpret diagrams, illustrations, or graphs. The presence of hearing or visual impairments may further complicate the receipt of information. The additional cognitive effort required just to absorb the information can create confusion about facts which might otherwise be understandable. Each of these details needs to be tailored to the abilities of the audience in order to promote successful learning.
Another potential obstacle to health literacy is the type and complexity of health information. Some topics are more highly publicized than others, which may lead professionals to assume mistakenly that these topics are general knowledge and don’t need to be reviewed. Other topics may contain highly detailed information, not all of which a learner may need or want to hear. The amount of information that should be presented at any one time may depend on the “wow” factor of the information. When new health information will be life-changing, the first sentence of the communication may be all that an individual is initially able to absorb. Thus, teaching about a cancer diagnosis should be approached much differently than teaching about the benefits of weight loss.
Simple obstacles that may sometimes be overlooked involve environmental factors. Is the doctor trying to explain something to you while you are still wearing a thin paper gown in a chilly exam room? Were you given an informational pamphlet to read while sitting in a noisy waiting room? Are you distracted by news that a friend shared during a phone call prior to your appointment? Did you skip breakfast and now you are expected to pay attention when the lunch hour is approaching? Environmental factors may not seem as important, but they can significantly affect the success of an educational opportunity.
Have some of these obstacles made an impact on your ability to think and act on health-related matters? What changes can you make to improve your health literacy? Next week we’ll wrap up our discussion of this topic.
Karen Kaslow, RN