Low health literacy can be a significant predictor of poor health status as well as negative outcomes such as increased levels of hospitalization and greater numbers of emergency department visits.
Low health literacy is a major challenge for healthcare and communications. Across the United States alone, around 90 million adults show low levels of health literacy. This could mean that individuals are unable to make decisions about their own care or for those they look after. They may not be able to understand the information on their medication label or the importance of taking their medication regularly, or how changing their behavior might improve their health. Low health literacy can be a significant predictor of poor health status as well as negative outcomes such as increased levels of hospitalization and greater numbers of emergency department visits.
The role of health literacy
As explained in our webinar Talking the patients' language – the importance of effective, patient-centered engagement, health literacy is one of the 3 pillars of patient communication and support:
- Instructional design
- Health literacy guidelines
- Behavior change models
Health literacy is more than just the basic ability to read health information. It is the ability of a patient and/or caregiver to track down and access basic health information, process and understand it, and then turn the information into action. However, health literacy is often forgotten in the development of communication material. It is crucial to keep this in mind when deploying tools and techniques to meet the health literacy level of the patients. Only then, the material can actually help to improve their understanding and engagement in treatment.
The National Institutes of Health Office of Communications and Public Liaison has created a Clear Communication initiative with 2 objectives:
- Providing information in the form and with the content that is accessible to specific audiences based on cultural respect.
- Incorporating plain language approaches and new technologies.
Creating the best and most usable materials, whether digital or print, involves looking at patients' needs, drivers and barriers, such as current knowledge of the disease, impact on their daily life, and issues of access, and developing multimodal support that meets all of these.
What the evidence says
The impact of low health literacy on patient outcomes is supported by evidence. In a systematic review of studies conducted in 2011, low health literacy was linked with:
- More hospitalizations
- Greater use of emergency care
- Lower receipt of mammography screening and influenza vaccine
- Poorer ability to demonstrate taking medications appropriately
- Poorer ability to interpret labels and health messages
- Among older people, poorer overall health status and higher mortality rates.
What the professionals say
During a recent webinar, our audience was asked "What is the core barrier to engaging patients/caregivers?" In what seems to be a disconnect with the evidence on health literacy, around a third said "time constraints" and another third said "patient/caregiver attitudes and beliefs," with only 6% suggesting that the issue was low health literacy.
Time constraints are always going to be a barrier for healthcare professionals, especially as the population ages and more people develop comorbidities. Patient and caregiver attitudes and beliefs are closely tied into their levels of health literacy, and one of the roles of clear communication is to break down incorrect beliefs, myths and misconceptions.
From the patient's perspective
As caregivers Keith and Judy explained in the same webinar, there are a number of points that are important to bear in mind when preparing information for patients. The most important being that all information must be easy to understand. This will need to take into account the age and educational level of the audience, their language skills (for example is English a second language?) and any cognitive challenges they may have. Different people will also process information in different ways, which may determine whether the information needs to be image- or text-driven.
Breaking information down into simple steps and providing tools, plans and checklists can be very helpful. Reiterating the information in other ways, such as through questions, a story or an analogy, can ensure that the patient has processed and understood the information.
When working with a family caregiver, healthcare professionals and people designing materials also need to remember that this role can be overwhelming, frustrating, and at times frightening. That variety of emotions can make it even more difficult for caregivers to absorb information, especially when talking about complex or life-changing therapies. But, it also means that they will likely be appreciative of anything that can make their caring responsibilities easier.
Understanding the patient and caregiver's level of health literacy is an important step to creating the right information and support at the right time, and to developing behavioral change approaches that will improve their outcomes and their quality of life.
Watch our on-demand webinar (registration required) to learn more about how to speak the patients' language.