Health Literacy A Prescription to End Confusion (2004) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-18
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The examples below were selected from the many pieces of complex consumer health information used in America. · From a research consent form: "A comparison of the effec tiveness of educational media in combination with a counseling method on smoking habits is being examined." (Doak et al., 1996)
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Even people with strong lit eracy skills may have trouble obtaining, understanding, and using health information: a surgeon may have trouble helping a family member with Medicare forms, a science teacher may not under stand information sent by a doctor about a brain function test, and an accountant may not know when to get a mammogram. This report defines health literacy 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" (Ratzan and Parker, 2000)
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. Many people who deal effectively with other aspects of their lives may find health information difficult to obtain, understand, or use.
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Individuals' health literacy skills and capacities are mediated by their education, culture, and language. Equally important are the communication and assessment skills of the people with whom individuals interact regarding health, as well as the ability of the media, the marketplace, and government agencies to provide health information in a manner appropriate to the audience.
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Health literacy involves a range of social and individual factors, and includes cultural and conceptual knowledge, listening, speaking, arithmetical, writing, and reading skills. However, most of the tools currently available to measure health literacy primarily measure reading skills, and do not include other critical skills.
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In addition, no current measures of health literacy include oral communication skills or writing skills and none measure the health literacy demands on individuals within different health contexts. THE EXTENT AND ASSOCIATIONS OF LIMITED HEALTH LITERACY Studies of health literacy or of literacy in health contexts suggest that limited health literacy skills, as measured by current assessment tools, are common, with significant variations in prevalence depending on the population sampled (see Chapter 3)
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Associations with Health Knowledge, Behavior, and Outcomes Research linking limited health literacy as it is currently measured to health knowledge, health behaviors, and health outcomes is accumulating. Patients with limited health literacy and chronic illness have less knowledge of illness management than those with higher health literacy (Kalichman et al., 2000; Schillinger et al., 2002; Williams et al., 1998a, b)
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A difference of $450 remained after controlling for health status, although the causality of the associations between health status and health-care cost could not be determined. In both analyses, higher emergency care costs were incurred by individuals with limited health literacy compared to those with marginal or adequate health literacy as measured by the Test of Functional Health Literacy in Adults (TOFHLA)
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Differing cultural and educational backgrounds between patients and providers, as well as between those who create health information and those who use it, may contribute to problems in health literacy. Culture, cultural processes, and cross-cultural interventions have been discussed in depth in several recent IOM reports and represent possible nexuses of culture and health literacy (IOM, 2002, 2003a)
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ABEL programs provide classes in topics that support health literacy including basic literacy and math skills, English language, and high school equivalence, and predominantly serve students with literacy and math skills in NALS Levels 1, 2, or the low end of NALS Level 3. Sadly, these programs serve far fewer than the millions of Americans who could benefit.
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Even highly skilled individuals may find the systems too complicated to understand, especially when these individuals are made more vulnerable by poor health. Directions, signs, and official documents, including informed consent forms, social services forms, public health information, medical instructions, and health education materials, often use jargon and technical language that make them unnecessarily difficult to use (Rudd et al., 2000b)
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Many different interventions and approaches that may hold promise for addressing limited health literacy are being attempted across health-care systems, professional organizations, federal and state agencies, educational institutions, and community and advocacy groups across the United States and in other countries. Those profiled in the report are indicators of the creativity and promise for future improvements in countering the effects of limited health literacy.
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· The cultural contexts of diverse peoples, including those from various cultural groups and non-English-speaking peoples, are integrated in to all health information. · Health practitioners communicate clearly during all interactions with their patients, using everyday vocabulary.
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Such measures should be devel oped for large ongoing population surveys, such as the National Assessment of Adult Literacy Survey, Medical Expenditure Panel Survey, and Behavioral Risk Factor Surveillance System, and the Medicare Beneficiaries Survey, as well as for institutional accreditation and quality assessment activities such as those carried out by the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance. Initially, the National Institutes of Health should convene a national consensus conference to initiate the development of operational measures of health literacy which would include contextual measures.
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Recommendation 5-3 The Health Resources and Services Administration and the Centers for Disease Control and Prevention, in collaboration with the Depart ment of Education, should fund demonstration projects in each state to attain the National Health Education Standards and to meet basic literacy requirements as they apply to health literacy. Recommendation 5-4 The Department of Education in association with the De partment of Health and Human Services should convene task forces comprised of appropriate education, health, and public policy experts to delineate specific, fea sible, and effective actions relevant agencies could take to improve health literacy through the nation's K-12 schools, 2-year and 4-year colleges and universities, and adult and vocational education.
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· Explore creative approaches to communicate health information using print ed and electronic materials and media in appropriate and clear language. Messag es must be appropriately translated and interpreted for diverse audiences.
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2002. Users of Internet health information: Differences by health status.
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2004. Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population.
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