October 1, 2019
Health Literacy: What It Is and How to Improve It
By Columba Quigley, MD
Stack of books

What Is Health Literacy?

Health literacy is the ability to access, understand, and act on information that affects one’s health. While literacy refers to the ability to read and write, health literacy is more complex. Many internal and external factors are at play, for instance, a person’s math skills and a healthcare provider’s cultural background. And while literacy informs a person’s ability to be successful in school or at work, health literacy can have life-or-death consequences. 

In addition, the economic toll of poor health literacy is between $108 and $328 billion per year. To put this in perspective, the potential savings of improved health literacy matches the cost of providing healthcare coverage to the nearly 50 million Americans who were uninsured in 2006 (based on U.S. Census Bureau estimates). When the future implications of poor health literacy are considered, this cost is predicted to compound to between $1.6 and $3.6 trillion. 

Why Health Literacy Is Important

Well-informed patients naturally feel more confident interacting with healthcare professionals and making medical decisions. Studies also suggest that patients with poor health literacy have worse medical outcomes. Broadly speaking, poor health literacy impacts adherence and compliance to medication. In clinical trials, poor health literacy impacts recruitment and retention.

Poor health literacy is also associated with decreased preventive care and increased use of emergency medical services, which are not only more costly to the patient and the healthcare system as a whole, but also reduce a patient’s chances of positive treatment outcomes due to delayed intervention. For instance, if a patient puts off seeing his/her doctor for a cough that turns out to be lung cancer, the prognosis is likely to be worse, and treatment options more limited, than a patient who had visited his/her doctor soon after symptoms arose. 

Put simply, proficient health literacy puts the patient in the driver’s seat, resulting in more consistent, compliant, and effective healthcare for the patient—and also one that is more cost-efficient.

Factors that Affect Health Literacy

Health literacy depends on a complex matrix of factors, including:

  • General communication skills
  • Cognitive abilities
  • Learning abilities
  • Educational opportunities
  • Culture
    • Cultural beliefs
    • Values
    • Traditions
    • Attitudes toward medicine
    • Language
  • Written literacy
  • Digital literacy
  • Visual literacy
  • Computational literacy

Depending on the situation (e.g., the patient/healthcare provider’s relationship or the environment), different combinations of these factors can come into play. For instance, a patient who shares the same cultural background as his/her healthcare provider may feel more comfortable and have an easier time communicating because they share not only the same language or dialect but also hold the same cultural beliefs and values.

5 Ways to Improve Health Literacy

Because health literacy is a systemic problem, the onus of improving it does not fall on the patient. Healthcare providers and institutions must work to better educate patients, meet them on their level, and ensure medical options, instructions, and treatment plans are fully understood. The following are some of the ways healthcare providers can improve the health literacy of their patients and their caregivers.

1. Improve Patient Educational Materials

Patient education is a collective term for the process in which doctors, nurses, and other healthcare professionals pass on information to their patients and their families or caregivers. The effectiveness of this process can have long-term impacts on patients’ health, both positive and negative.  

Today, this information transfer can take place in a variety of ways—from the traditional pamphlets you see in waiting rooms to podcasts, videos, and even comic books. Whatever the method, the most important thing for healthcare professionals to remember when selecting resources for their patients is to meet them on their level. For instance, educational materials for children should be engaging, relatable, and visually compelling. When patients are able to connect with educational materials in a more meaningful way, they are better able to receive and retain the often complicated information being imparted to them.    

Check out Jumo Health’s collection of age-appropriate educational materials.

2. Provide Regular Staff Education

To improve patient education, and consequently health literacy, medical staff must be trained in best practices for delivering educational material. Therefore, all staff should receive regular, standardized training on how to best educate patients.

3. Use Plain Language When Communicating With Patients

Plain language refers to communication that can be understood by the recipient the first time it’s presented. Using plain language is one way healthcare providers can help improve health literacy. By using clear terminology, patients have a much better chance of understanding their condition, options, treatment plan, and doctor’s instructions. Plain language can also help break down other potential barriers to communication, like the sense of inferiority that comes with feeling like you’re being talked down to. This is true of both conversational and written communication. 

It’s also important to note that what is considered to be plain language to one person may not be to another. For this reason, testing your plain language communication with patients can help determine where gaps may still exist and where adjustments may need to be made (on a person-by-person or community basis).

When used effectively, plain language can go a long way toward satisfying the main components of health literacy: enabling the patient to better access, understand, and act on the (often) complicated information being presented to them. Some of the ways healthcare providers can incorporate plain language practices into their communication include:

  • Using active voice as much as possible
  • Using a hierarchical approach (starting with the most important information)
  • Avoiding jargon
  • Taking time to break down complicated topics and terminology

Along with using plain language as a best practice, healthcare providers should also be sure to clearly spell out the basics: what, why, when, and how. For instance, when antibiotics are prescribed, it’s important that a healthcare provider explains the purpose of the drug and how it will affect the patient’s condition, why it must be taken twice per day for the duration of the prescription (and the consequences of not doing so), and how it should be taken with food to prevent nausea. It can be easy for healthcare providers to gloss over these seemingly small, but important details after having prescribed the same medication hundreds of times over the years.

4. Demonstrate Cultural Competency

Because culture plays a large role in how people communicate, healthcare providers must pay special attention to how they transmit information to patients with different cultural backgrounds. As mentioned above, differences in a patient and their healthcare provider’s cultural beliefs, values, traditions, and attitudes toward medicine—and, of course, language—can all be barriers to effective communication. 

When healthcare providers address patients of different cultural backgrounds in a respectful and culturally relevant manner, there is a much better chance the patient will hear and retain the crucial information being conveyed. In addition to being conscientious of how patients are addressed, there are many resources available to healthcare providers who want to become more culturally competent. This investment can make a noticeable difference in treatment outcomes. 

In terms of language, the National Standards for Culturally and Linguistically Appropriate Services in Health Care recommends that healthcare providers offer language assistance services at no cost to the patient. In fact, most states (as well as Title VI of the Civil Rights Act of 1964) now require this. While it’s ideal for medical offices to have bilingual employees on staff, translation services and interpreters can also help bridge communication gaps for patients with limited English proficiency. The standards report also advocates for having educational and print materials available in languages that are common to regional populations.

5. Request Patient Feedback

Despite healthcare professionals’ sound intentions of accurately communicating medical information, the intricacies of the message can easily be lost in translation. For instance, a patient with proficient health literacy skills receiving a life-changing diagnosis from their doctor may not fully process the conversation or retain some of the more crucial details. The emotional impact of the diagnosis may temporarily affect the patient’s ability to process information, and some important details of the condition may not be received and understood as intended.

This is where feedback comes in. Soliciting patient feedback is a solid way of not only assessing health literacy but also ensuring the information given matches the information received by the patient. This feedback could come through a variety of methods, which should be used in tandem for best results, including:

  • Asking a patient to repeat information back to you (also referred to as the “teach-back” method)
  • Allowing time for questions and answers at the end of an office visit
  • Following up with a phone call after a visit
  • Administering patient experience surveys     

Low Health Literacy: Who is at Risk?

While there is a correlation between literacy and health literacy, no one is immune from health literacy challenges. Only 12% of American adults are considered proficient in health literacy and more than a third have only “basic” or “below basic” health literacy levels. This equates to nearly 80 million Americans who have trouble following simple medical instructions provided by their medical professional or making the appropriate determinations on whether treatment should be sought, for example. 

The following are some of the populations most at risk of health literacy challenges:

  • Older adults
  • Minority populations
  • Uninsured populations
  • Low-income populations
  • Populations with limited education
  • Populations with limited or no English proficiency
  • Immigrant and refugee populations

Older Adults

Adults 65 years of age or older have been shown to have lower health literacy levels than those under 65. This disparity is most striking for the 75-and-over group, with more than two-thirds of adults showing basic or below basic health literacy skills.

Minority Populations

While adults in any racial and ethnic group can have basic or below basic health literacy, white/Caucasion adults represent the smallest portion (28%) in these categories. By contrast, 66% of Hispanic adults have basic or below basic health literacy skills, and black/African-American adults have 57%. When the below basic category is considered on its own, 41% of white/Caucasion adults and 35% of Hispanic adults make up this designation.

Uninsured Populations

The uninsured and those with Medicaid or Medicare are four times more likely to have below basic health literacy skills than those with employer-provided insurance. For those with employer-provided insurance, the proportion of adults with basic or below basic health literacy is approximately one-fourth, whereas more than half of the uninsured population and those with Medicaid or Medicare make up these groups.

Low-Income Populations

Lower incomes are also associated with poor health literacy. Those living below, at, or just above the poverty level have an average health literacy in the basic range, compared to intermediate (just below proficient) for those whose income is at least 175% of the poverty level.

Populations with Limited Education

Education and health literacy are closely linked. For instance, only 1% of those with less than a high school education are considered proficient in health literacy, compared to 30% of those with a bachelor’s degree. The story is even more telling for the group with below basic health literacy; 49% of those with less than a high school degree and just 3% of those with a college degree fall into this category.

Populations with Limited or No English Proficiency

Because English proficiency is a prerequisite for health literacy in America, populations with limited or no English language skills are at increased risk of having poor health literacy. 

Immigrant and Refugee Populations

The American healthcare system is complex and can be difficult to navigate for those who were born here, let alone those who were not. For immigrants and refugees coming from other countries with entirely different healthcare services, practices, and insurance systems, it can be overwhelmingly complicated.

Columba Quigley, MD
Mother, physician, writer, cellist, (over)thinker. Lover of comics. Editor-in-Chief at Jumo Health

Jumo Health develops age-appropriate, culturally relevant, and relatable educational resources for patients and caregivers. We have experience serving diverse populations, covering more than 160 health topics across 80+ countries in 120+ languages. Our various digital, video, and print offerings use highly visual elements and research-backed health literacy strategies to ensure that everyone can understand and act upon complex medical information. We do this through familiar mediums – from comic books and animation, to virtual reality experiences and authentic documentary-style patient stories – all customized based on audience. Jumo Health collaborates globally with more than 180 advocacy groups and community organizations to promote access and to ensure unique patient experiences are accurately represented.

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