Jarret Patton MD
Illiteracy has different faces, its not always easy to identify.
Just as summer is in full swing, the “back to school” advertisements are running. This time of year can be exciting for many; the first day of elementary school, high school or college. For the rest of us, we try to be lifelong learners; learning from our successes and failures, learning from others and if we are lucky learning by reading.
Reading is a skill learned in the early school years. Children spend the first few years of their education learning how to read. After that period ends, in the third or fourth grade, children read to learn. Unfortunately, many of our nation’s school districts have poor reading proficiency by the time children reach and finish high school. This is particularly true of many of our urban and rural school districts. Without good reading skills, life can be challenging.
Literacy is often assumed in most professions, healthcare is not excluded. It is estimated that there are 23 million adults in the U.S. with limited literacy, defined as below basic literacy or non-literate. Often when this population comes to us for help, we ignore the signs of limited literacy. These signs include complaining about forgetting their glasses or being unable to see, having difficulty or taking an extraordinary amount of time filling out forms. This does not include the people made to complete forms in English when they primarily speak another language. When language is considered, the number with below basic literacy or worse is over 30 million.
With so many people having low or limited literacy, one would think healthcare does a good job at providing healthcare instructions in the preferred language. After all, most electronic health records (EHRs) have patient instructions in different languages. However, it may take extra clicks or extra time to load so it doesn’t happen as often as needed. In addition, many pharmacies are able to dispense medication instructions in other languages only if requested by the prescriber. When basic instructions aren’t understood, errors are bound to occur. Low literacy and limited English proficiency have been known to affect hospitalizations, readmissions, morbidity and mortality. If we don’t do this right in healthcare where the stakes are high, why should other industries care?
Fortunately, most adults are literate; however they can also have difficulty navigating our complicated healthcare system. Health literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. Simply stated, the ability of adults to comprehend and use health-related information.
Health literacy has important implications for the ongoing care of many. Studies have attempted to measure health literacy with screening tools or signature time at registration. Various populations have been studied from adolescents to military personnel. However, the elderly seem to have the most trouble with health literacy. This is likely due to the fact they have complex medication regimens and the 18 pages of instructions printed by the EHR is too difficult to follow. This leads to them making mistakes following their discharge instructions thus leading to readmissions and further hospitalizations.
Although many of us work in highly technological and perhaps scientific fields, we need to be wary of those that have limited literacy. We should make our communication simple and understandable, both spoken and written, in the preferred language. Most of all, we need to ensure that we are not overlooking an often under recognized issue- health literacy.
White S. Assessing the Nation's Health Literacy: Key concepts and findings of the National Assessment of Adult Literacy (NAAL). AMA Foundation. 2008.