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Health Literacy

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Case for Change

Communication is the backbone of health care delivery. Patients offer their symptoms, concerns, and medical histories. In return, providers discuss ailments and illnesses while describing solutions and treatments. The success of a treatment hinges largely on the communication between the patient and the provider. Unfortunately, this can be an obstacle for many patients.

Millions of U.S. adults possess literacy skills below-high school levels. Twenty percent of U.S. adults read at or below the fifth grade level. Iowa literacy rates are also low, with 38 percent of adults reading at below-high school levels. While individuals with low literacy levels may struggle with many areas of their life, the problem is particularly germane to health care. In this context, it is referred to as "health literacy." Health literacy is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."

Patients with low health literacy have difficulty accessing the medical world, a world filled with jargon, acronyms, and arcane language. This limited understanding can manifest itself in numerous ways. Patients may: Health care professionals cannot increase the literacy rates of their patients. Instead, providers must acknowledge these low health literacy rates and alter their delivery of care accordingly. This step toward improving health literacy focuses on the following areas: This toolkit will: Sources:

Tool Kit


1. Guidelines



2. Planning and Implementation - Writing Easy-To-Read Materials



3. Policies and Procedures



4. Culturally Effective Care



5. Educational Materials

  1. Physician
    1. "What did the doctor say?:" Improving Health Literacy to Protect Patient Safety
      1. Joint commission's white paper on health literacy

      2. http://www.jointcommission.org/PatientSafety/SpeakUp/

    2. Ask Me 3 Program for Providers
      1. http://www.npsf.org/askme3/PCHC/

    3. Institute for Healthcare Advancement Health Literacy Conference
      1. http://www.iha4health.org/

    4. National Quality Forum: Improving Informed Consent for Patients with Limited Health Literacy
      1. http://www.qualityforum.org/pdf/reports/informed_consent.pdf

    5. Pfizer Principles for Clear Health Communication (PDF 860KB)


  2. Patient
    1. Plain Language Materials
      1. Resources to improve communication regarding various conditions such as asthma, arthritis, and lupus, and other resources including plain language materials for seniors.

      2. Harvard School of Public Health, Health Literacy Studies. Information, including plain-language materials (WEBSITE)

    2. Ask Me 3 Program for Patients
      1. http://www.npsf.org/askme3/for_patients.php

    3. Lay Terms for Medical Terminology (PDF 43KB)


6. Other

  1. A. Information on Readability
    1. http://www.gopdg.com/plainlanguage/readability.html



Success Stories


Allen Hospital, Waterloo

Allen began addressing health literacy in collaboration with Iowa Health System in 2003. As a result of those efforts, the following have been implemented: The Patient Education Committee makes recommendations to improve patient and family understanding of their care, thus overseeing the implementation of projects related to health literacy. The Patient Advocacy Committee is consulted as projects are developed and implemented, allowing for consumer input into the products developed.

Future endeavors include conversion of additional consents used in the hospital to become more literate. We continue to evaluate areas where patient and family education occur, in order to assure health literate materials are available.


Mentors

IHC would like to thank those individuals and organizations who have shared their materials and who have agreed to serve as mentors. Please contact IHC if your organization would like to contribute materials to this tool kit. The project team includes Mary Ann Abrams, MD, MPH, of Iowa Health System, as well as representatives from the Iowa Department of Public Health and Iowa health care providers.

Resources


1. Other Tool Kits

  1. IDPH's Plain and Simple Project
    1. Plain & Simple: A health literacy project for Iowa is aimed at helping public health workers and partners use plain language when writing or speaking about health.

    2. http://www.idph.state.ia.us/health_literacy/default.asp

  2. Speak Up
    1. Joint Commission's award winning patient safety program

    2. http://www.jointcommission.org/PatientSafety/SpeakUp/

  3. Pfizer Health Literacy Tool Kit
    1. http://www.pfizerhealthliteracy.com/physicians-providers/default.html

  4. United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion.
    1. Tools for Improving Health Literacy


2. Articles

  1. "Eradicating Low Health Literacy: The First Public Health Movement of the 21st Century." Pfizer White Paper, 2003. (PDF 112KB)

  2. Healthy People 2010 - Health Communication Information and Materials (WEBSITE)

  3. "Adequate Literacy and Health Literacy: Prerequisites for Informed Health Care Decision Making: A Research Report." Dubow J. AARP Public Policy Institute, June 2004. (WEBSITE)

  4. "Communicating Health: Priorities and Strategies for Progress." U.S. Department of Health and Human Services, July 2003. (WEBSITE)

  5. "Health and Literacy Working Together: A Health Literacy Conference for New Readers & Health Professionals." Helen Osborne, Post-conference September 10-11, 2004, Des Moines, IA. (PDF 207KB)

  6. "Low Health Literacy: What Do Your Patients Really Understand?" Joanne G. Schwartzberg. Nursing Economics, May 1, 2002; 20(3): 145. (WEBSITE/PDF)

  7. "Promising Practices for Patient-Centered Communication with Vulnerable Populations: Examples from Eight Hospitals." Wynia M & Matiasek J. American Medical Association Institute for Ethics. 2006. (PDF 334KB)

  8. "Quick Assessment of Literacy in Primary Care: The Newest Vital Sign." Weiss BD, et al. Annals of Family Medicine, 2005; 3: 514-522. (WEBSITE)/li>


3. Books

  1. Health Literacy: A Prescription to End Confusion. Nielsen-Bohlman L, et al. (eds). National Academies Press, 2004. (WEBSITE)

  2. Advancing Health Literacy: A Framework for Understanding and Action. Zarcadoolas C, et al. Jossey-Bass, 2006. (WEBSITE)

  3. Health Literacy from A to Z: Practical Ways to Communicate Your Health. Osborne, H. Jones and Bartlett Publishers, Inc., 2004. (WEBSITE)

  4. Understanding Health Literacy: Implications for Medicine and Public Health. Schwartzberg JG, et al. (eds). American Medical Association, 2004. (WEBSITE)

  5. Teaching Patients with Low Literacy Skills. Doak CC, et al. Lippincott Williams & Wilkins, 1996. (WEBSITE)


4. Websites

  1. American College of Physicians Foundation: Promoting Health Literacy
    1. http://foundation.acponline.org/index.htm

  2. American Medical Association - health literacy project.

  3. Ask Me 3

  4. Coalition for Health Communication.

  5. Institute of Medicine


5. Consultants

  1. Clear Language Group - development of health literacy, plain language, cross-cultural communications (WEBSITE)

  2. Health Literacy Consulting (WEBSITE)

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