Health Literacy

More than 90 million adults in the United States have poor literacy, leading to greater difficulty navigating the health care system and increased risk for poorer health outcomes (Andrus and Roth, 2002; Berkman et al., 2004). Health literacy refers to patients' ability to read and understand instructions, to give informed consent, and to comprehend, absorb, and retain information presented. Low-health literacy skills are not limited to patients with low intelligence, those with lower educational levels, or those of lower socioeconomic status.

Patients experience low literacy in a number of ways. Although some individuals may never have learned to read, others may be able to read the words but are unable to attach meaning to what is written. Difficulties may reflect differences in level of language use between the physician and patient or language barriers when the patient and physician are from different cultures. Regardless of the cause, if patients are unable to read or understand the material presented, they receive little benefit.

The best method of assessment of the degree of literacy involves observing, being alert to cues, and conducting sensitive and timely direct questioning. Several instruments have been developed to assess medical literacy (Davis et al., 1998). A good example is the rapid estimate of adult literacy in medicine (REALM), a word recognition test designed for patients in health care settings (Davis et al., 1993).

In some situations, visual presentation of concepts may help patients comprehend and remember information presented. In other cases, giving smaller amounts of information over several visits may be the most effective means to enhance patients' ability to absorb information. Written materials given to the patient should contain only essential information that is arranged in logical sequence and related to what the patient must know or do, rather than in-depth explanations.

When the literacy problem involves fluency or vocabulary, the physician should be especially cautious not to use jargon or assume that all "common" words or terms will be familiar to the patient. Using terms the patient knows and analogies of familiar themes may be helpful in assisting the patient to understand and remember concepts. When language is the specific problem, the physician may find it useful to use a third party fluent in both languages to assess the patient's understanding of the material presented.

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