By Audrey Landers
Health literacy is the combination of basic reading and numerical skills that enables someone to understand the health information and services needed for healthy decision making.
99% of adults in the United States are literate, while only 12% are considered to be proficiently health literate with 14% being considered below basic. What causes this enormous gap? One cause is that the reading level which is required to considered to be literate and health literate are vastly different. In order to be literate a person must be able to read at some level, with no qualifying benchmark for how well they must be able to do so.
The majority of adults read at an eight grade level, with 20% reading at a fifth grade level or below. Meanwhile, most medical documents are written at a tenth grade level. This difference means that even well-educated adults can have difficulty comprehending healthcare and reality is even more grim for those who only have basic literacy skills.
Those who suffer the most from low health literacy are often those with other disadvantages. Elderly patients who may have trouble with their memory or with understanding new concepts, non-native English speakers and those from low-income families are most vulnerable to the problems that low health literacy creates. Those who are health illiterate are more likely to have difficulty understanding (and taking) medications, less likely to participate in activities that promote wellness and are hospitalized more often.
What can you do to help?
While increasing health literacy may seem like David vs Goliath to most physicians, there are a few things you can do in your own practice to help give patients the opportunity to understand more about their health.
First, by learning how to identify those who may have extremely low health literacy, you can personalize the care you give them to their needs. Here are a few signs to look for:
- The patient needs help to fill out forms
- The patient puts off decision making and instruction reading
- The patient is a chronic no-show
- The patient has difficulty complying with medication and recommended lifestyle changes
Be aware of your language. Health literacy also refers to a patient’s ability to understand spoken language in medical settings. To make yourself understood in the exam room you should be aware that some words can have very different meanings and implications in “medicalese” verses common English. One example is the word “diet” which to a physician may just mean what food someone eats but to a patient it means going on a diet like atkins or paleo.
Be specific. How many times have you told a patient to “come back if you get worse?” What does “get worse” mean exactly? This question is disastrous when combined with a new prescription that could have side effects that would confuse a patient. Instead, give patients specific symptoms and signs to look for whenever possible.
Use the “teach back” method. After giving a patient instructions on how to perform a task or take medication, instead of asking if they understood you, ask them to explain it back to you. By using this method, you can gauge what the patient understands and will know what exactly they have trouble with if they aren’t getting something.
Make it easy. One common piece of advice for educating patients is to give them a printed handout with the information and instructions they need on it. As mentioned above, most healthcare documents are written at a tenth grade level, meaning that even if you give your patient information to take home they may not be able to fully understand it. To combat this, it is recommended that any patient education material should be written at the sixth grade level or lower. You should also include easy-to-understand pictures and graphics when possible. The US National Library of Medicine has a great guide for writing easy-to-read heath materials.
To give you a general idea of what grade-level writing looks like, I put this blog post through a readability checker and found that it is written at about the eleventh grade level.