Life-Saving Health Literacy

An estimated 90 million American adults have difficulty understanding and using health information.  The reason for this is not stress, fatigue or confusing instructions, it is the inability to read and understand what is written.  The epidemic of health illiteracy is not confined to the poor or elderly and it is of grave concern to health care providers because of the dangerous consequences to the individual.   The strongest predictor of an individual’s health status is not age, race, or ethnicity but literacy.

 

Many are embarrassed or ashamed to admit that they cannot read or do not understand what they read.  Others learn to make excuses for this obstacle, “I forgot my glasses” or “I don’t understand what to do, can you explain (show) it to me?”  And some patients normally capable of reading and comprehending begin to experience challenges with the strange lexicon and fast pace of the healthcare industry.

Asking questions like, “Can you read?” or “Do you understand this instruction?” can be awkward for both the individual and the health care professional.  Yet knowing the answer to those questions is imperative because individuals with low health literacy and comprehension are less likely to comply with prescribed treatment and self-care regimens.  

There are a variety of tools in use that can evaluate an individual’s ability to read and understand.  In health care, we often look for a tool that is quick to use and easy to evaluate.  One simple assessment includes asking an individual to read a food label and then asking them questions to determine if they understood what they read; for example, if the label says the product has 100 calories per serving and there are 3 servings in the box, how many calories would they consume if they ate the entire box? Or asking them to pretend they are allergic to peanuts, and then asking if they could eat this product based on the label?  This is more than a reading and comprehension test; it is an important health education tool related to nutrition.  Food labels are tricky for anyone to understand.  A new initiative will soon require the most important facts regarding the product be displayed in an easy-to-read label on the front of the food container.

Developing an appropriate plan to teach the individual what they need to know to regain and maintain their health can be accomplished despite their literacy challenges, but the process is made easier if the family caregiver makes health care professionals aware of the individual’s inability to read or comprehension challenges.  To compensate, healthcare professionals may use picture-based tools and techniques, like pictures to describe symptoms or facial images to demonstrate differing degrees of pain.  Or they may ask the individual to repeat the skill they have been taught several times. 

There are many creative options to help patients who cannot understand written instructions.  These techniques can easily be taught and used by family caregivers.  The first step is simply to express the need.  The most important words any patient can express are these, “I don’t understand.”