Health Literacy: Improving Quality of Care in Primary Care Settings

Abstract

Health Literacy: Improving Quality of Care in Primary Care Settings Sharon E. Barrett, MS, Doctoral Candidate, MSUPHP Jennifer Sheen Puryear, MPH A 78 year old woman struggles to read the label on her prescription bottle. She knows she needs to take her blood pressure medication, but cannot read the label on the bottle to determine which one is her blood pressure medicine, nor how many she should take, so she picks one. She remembers the doctor told her to take the medicine twice a day so she takes two pills at one time. In an exam room, a 45 year old Hispanic male nods and agrees to what his doctor is telling him in English about diabetes when he came in for knee pain. He leaves unsure of what has happened. His knee still hurts and he doesn't know what diabetes is or why he is discussing it with him. English is not his primary language. In another exam room, a 50 year old Mung patient wonders why the doctor keeps asking her questions about her medical history when all she wants is medicine for her chronic stomach pain. She is not comfortable talking to the doctor and thinks he must not be very good if he has to ask her so many questions.* Good patient-clinician communication, where patients are able to understand the health information and treatment recommendations they receive and feel comfortable enough to ask questions or admit when they do not understand something, is vital to the successful management of a chronic illness. However, achieving this ideal level of communication is difficult due to individual and cultural differences in the way patients understand health concepts, view their role in their own health care, and how they view the role of clinicians. Patient-clinician communication is an umbrella under which different facets of the patient-clinician relationship, such as health literacy, culture and communication, rest. Communication, verbal, non-verbal, or written, must be sensitive to patients' language proficiency and reading ability and should be examined within the context of a patient's culture. Understanding the issues of health literacy, culture, and communication and its implications is a lynch pin to improving patient and clinician communication, quality care, and self-management of chronic health conditions. [End Page 690] What is Health Literacy? In the 2004 report by the Institute of Medicine (IOM) entitled Health Literacy: a Prescription to End Confusion, health literacy was defined as "the ability to read, understand and act on health information."1 Low health literacy can mean not being able to complete office visit and consent-to-treat forms, sign HIPAA documents, or read printed material. Being a health literate individual means that you understand your provider's recommendations, can take medication correctly, properly use home medical devices, and know where to go and who to seek out when you need help. It means being able to communicate with your care providers to understand your health condition, consider different treatment options, and make informed decisions about the approach to be taken to resolve or manage a health problem. It is the ability to navigate the health care system and feel confident to participate in a dialogue that results in shared decision making. It also means that, as a patient, you are able to understand health information and respond to treatment recommendations made by the clinician, when that clinician accommodates your cultural and linguistic background. For it is culture, made up by beliefs and traditions valued by the patient, that influences the patient's response to what the clinician communicates. Who is Affected by Low Health Literacy? The 2004 IOM report clearly states, ". . . nearly half of all American adults—90 million people—have difficulty understanding and acting upon health information."1 According to recently conducted NAALS data, this figure is estimated to be at 77 million individuals due to the establishment of...