“Health literacy is a constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment. Patients with adequate health literacy can read, understand, and act on health information.” (Health literacy: Report of the Council on Scientific Affairs, JAMA, 1999)
It's estimated that 36 percent of American adults have low or limited levels of Health Literacy (The Health Literacy of America's Adults, NAAL, 2003) Populations at risk of low or limited Health Literacy include:
A patient with low HL might:
Low or limited levels of Health Literacy can be correlated to:
The 2006 report, Low Health Literacy: Implications for National Health Policy, estimated that low health literacy costs the US economy in the range of $106 to 238 billion a year- enough to insure an additional 47 million Americans.
Imagine that you are given the task of creating an origami swan-without instructions. Would you know how? Some people would try to figure it out by looking at the photograph. Some might seek help from a friend or relative. Others might go online to look up instructions. And a lot of people would just give up.
For many people, navigating the health care system is a lot like making a swan.It's an unfamiliar environment full of specialized terminology, jargon, acronyms. You are not only expected to understand this information, but make an informed decision about it. And the consequences of your choice may have a devastating impact on your health.
You might not be able to tell if a patient has low or limited health literacy. In fact, your patient can have high literacy or numeracy skills, yet low health literacy skills. Stress and anxiety about the medical setting may interfere with communication. Physicians routinely overestimate the HL skills of patients in the clinical setting, especially in minority populations. Consequently, the use of medical terminology and jargon increases while comprehension decreases, setting the patient up for poor outcomes.
Look for cues that a patient does not understand. When presented with information, a patient with low HL might:
It's important to remember that patients with low literacy skills may not have told anyone about their difficulties. Low or limited literacy might be a source of significant shame and embarrassment for the patient, and they may have developed coping mechanisms.
How to help patients
There are simple actions healthcare staff can take to help assess a patient's literacy level.
Knowing which patients might be in the high risk for low literacy category can help the provider adjust the conversation for better communication.
Short Assessment of Health Literacy (SAHL) available in Spanish and English
The test contains 18 terms with related and distractor terms. It takes approximately 2-3 minutes to administer and evaluates both comprehension and pronunciation.
REALM is available in short form (7 items) and long (66 items). Patient is given 5 seconds to read aloud medical terms such as "antibiotics". Scoring is based on a simple 0-7 word score.
TOFHLA is available in both short and long forms. It contains both reading comprehension and numeracy, and is available in Spanish and English.
Newest Vital Sign (NVS)
NVS takes approximately three minutes to administer. It contains 6 questions based on a nutrition label. NVS is available free from Pfizer.
NAAL contains 28 questions that assess 3 areas of health related tasks-clinical, preventive and navigation.