Impact of Health Literacy on Eye Health Disparities

Abstract

Disparity in health literacy is a fundamental factor behind why preventable vision loss disproportionately impacts certain communities. Lower health literacy has been associated with higher rates of retinopathy in patients with diabetes and decreased adherence to treatment in patients with glaucoma.1Schillinger D. Grumbach K. Piette J. et al.Association of health literacy with diabetes outcomes.JAMA. 2002; 288: 475-482Crossref PubMed Scopus (1276) Google Scholar,2Muir K.B. Christensen L. Bosworth H. Health literacy and glaucoma.Curr Opin Ophthalmol. 2013; 24: 119-124Crossref PubMed Scopus (11) Google Scholar The US Government’s Healthy People 2030 initiative defines personal health literacy as the degree to which individuals can find, understand, and use information and services to make health-related decisions.3U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.https://health.gov/our-work/healthy-people/healthy-people-2030/health-literacy-healthy-people-2030Date accessed: December 10, 2021Google Scholar The initiative also acknowledges organizational health literacy, emphasizing not only the ability of individuals to process health information and use it to make well-informed decisions but also the responsibility of organizations to make health information and services equitably accessible and comprehensible to individuals.The average US citizen reads at an eighth-grade level, and the average Medicare beneficiary reads at a fifth-grade level.4Stossel L.M. Segar N. Giatto P. et al.Readability of patient education materials available at the point of care.J Gen Intern Med. 2012; 27: 1165-1170Crossref PubMed Scopus (121) Google Scholar The proportion of adults with basic or below basic health literacy in the United States ranges from 28% of White adults to 65% of Hispanic adults.5National Institutes of Health, National Eye Institute2005 survey of public knowledge, attitudes, and practices (KAP) related to eye health and disease.https://wayback.archive-it.org/1170/20190409132843/https://www.nei.nih.gov/sites/default/files/nei-pdfs/2005KAPFinalRpt.pdfDate accessed: August 27, 2021Google Scholar White and Asian/Pacific Islander adults have the highest average health literacy among other racial/ethnic groups, whereas Hispanic adults have the lowest. Regarding knowledge about vision health, individuals with higher income and educational attainment have greater awareness of eye health. Hispanic Americans are less likely to have knowledge of eye health and disease than Whites, Blacks, and Asian Americans.6America’s Health Literacy: Why We Need Accessible Health Information. https://www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/dhhs-2008-issue-brief.pdf. Accessed December 10, 2021.Google ScholarHealth disparities not only result from patient-associated factors including health literacy but are also a product of the physician–patient encounter. Professionals need to effectively communicate across cultures, understand the populations they serve, and be knowledgeable about eye diseases and screening guidelines. Inadequacies in training because of ophthalmology’s limited curricular time and clinical exposure at medical school and residency levels may affect referral patterns of patients at risk, highlighting the importance of educating not only patients but also physicians.Regarding patient education preferences, information from health professionals is one of the most important sources of information. All adults, irrespective of health literacy skills, are least likely to get health information from print media compared with nonprint sources. Video-based material may be preferable to reading material as a patient education tool.Electronic sources have the potential of enhancing health outcomes; however, they may digitally marginalize socially disadvantaged groups with lower access and skills to use technologies. A study found that people who sought health or medical information were mostly female, younger than 50 years of age, and non-Hispanic white; had some college education; had an annual household income of $50 000 or greater; and resided in a metropolitan area.7Finney Rutten L.J. Blake K.D. Greenberg-Worisek A.J. et al.Online health information seeking among US adults: measuring progress toward a Healthy People 2020 Objective.Public Health Rep. 2019; 134: 617-625Crossref PubMed Scopus (74) Google Scholar On the contrary, a study of patients with macular degeneration, glaucoma, or diabetic retinopathy revealed that characteristics associated with less likelihood to use the Internet included older age, Black race, Hispanic ethnicity, and lower educational attainment.8Stagg B.C. Gupta D. Ehrlich J.R. et al.Evaluation for disparities in experience with internet-based health care among US patients with chronic eye diseases.JAMA Ophthalmol. 2020; 138: 1097-1099Crossref PubMed Scopus (2) Google ScholarDetermining the best strategies to educate vulnerable populations and their care professionals about eye health are 2 of the many steps necessary to reduce eye health disparities. The following recommendations may serve as guidelines for patient and physician education.Patient Education1.Keep readability of patient education materials at a fourth- to sixth-grade reading level. Provide in-office education using visual aids, picture-based instructions, and videos.2.Tailor messages toward the intended population. Target individuals at higher risk of ocular disorders and health inequities, including the elderly population, those with diabetes, Blacks, Hispanics, Native Americans, people living in poverty, and residents of medically underserved and rural areas.3.Inform patients about reliable sources of educational materials including online resources and social media.Physician Education1.Educate primary care professionals on the importance of vision screening. Encourage evidence-based and approved consensus-based guidelines for eye exams.2.Develop awareness of eye healthcare disparities among various socioeconomic and cultural backgrounds. Support implicit bias and cultural humility training.3.Promote education in ophthalmology at medical schools and in residency training for family medicine, internal medicine, and pediatric programs.4.Increase research to measure health literacy, identify eye health knowledge gaps, and develop, implement, and evaluate interventions to improve health literacy and vision outcomes.Addressing eye health care disparities requires better dissemination of health information and optimization of health literacy in ophthalmology. The American Academy of Ophthalmology launched a task force to explore health care disparities in ophthalmology, signaling that this issue is a high priority. Reports of this task force will increase awareness of the current situation and serve as a call to action to mitigate health disparities. Disparity in health literacy is a fundamental factor behind why preventable vision loss disproportionately impacts certain communities. Lower health literacy has been associated with higher rates of retinopathy in patients with diabetes and decreased adherence to treatment in patients with glaucoma.1Schillinger D. Grumbach K. Piette J. et al.Association of health literacy with diabetes outcomes.JAMA. 2002; 288: 475-482Crossref PubMed Scopus (1276) Google Scholar,2Muir K.B. Christensen L. Bosworth H. Health literacy and glaucoma.Curr Opin Ophthalmol. 2013; 24: 119-124Crossref PubMed Scopus (11) Google Scholar The US Government’s Healthy People 2030 initiative defines personal health literacy as the degree to which individuals can find, understand, and use information and services to make health-related decisions.3U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.https://health.gov/our-work/healthy-people/healthy-people-2030/health-literacy-healthy-people-2030Date accessed: December 10, 2021Google Scholar The initiative also acknowledges organizational health literacy, emphasizing not only the ability of individuals to process health information and use it to make well-informed decisions but also the responsibility of organizations to make health information and services equitably accessible and comprehensible to individuals. The average US citizen reads at an eighth-grade level, and the average Medicare beneficiary reads at a fifth-grade level.4Stossel L.M. Segar N. Giatto P. et al.Readability of patient education materials available at the point of care.J Gen Intern Med. 2012; 27: 1165-1170Crossref PubMed Scopus (121) Google Scholar The proportion of adults with basic or below basic health literacy in the United States ranges from 28% of White adults to 65% of Hispanic adults.5National Institutes of Health, National Eye Institute2005 survey of public knowledge, attitudes, and practices (KAP) related to eye health and disease.https://wayback.archive-it.org/1170/20190409132843/https://www.nei.nih.gov/sites/default/files/nei-pdfs/2005KAPFinalRpt.pdfDate accessed: August 27, 2021Google Scholar White and Asian/Pacific Islander adults have the highest average health literacy among other racial/ethnic groups, whereas Hispanic adults have the lowest. Regarding knowledge about vision health, individuals with higher income and educational attainment have greater awareness of eye health. Hispanic Americans are less likely to have knowledge of eye health and disease than Whites, Blacks, and Asian Americans.6America’s Health Literacy: Why We Need Accessible Health Information. https://www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/dhhs-2008-issue-brief.pdf. Accessed December 10, 2021.Google Scholar Health disparities not only result from patient-associated factors including health literacy but are also a product of the physician–patient encounter. Professionals need to effectively communicate across cultures, understand the populations they serve, and be knowledgeable about eye diseases and screening guidelines. Inadequacies in training because of ophthalmology’s limited curricular time and clinical exposure at medical school and residency levels may affect referral patterns of patients at risk, highlighting the importance of educating not only patients but also physicians. Regarding patient education preferences, information from health professionals is one of the most important sources of information. All adults, irrespective of health literacy skills, are least likely to get health information from print media compared with nonprint sources. Video-based material may be preferable to reading material as a patient education tool. Electronic sources have the potential of enhancing health outcomes; however, they may digitally marginalize socially disadvantaged groups with lower access and skills to use technologies. A study found that people who sought health or medical information were mostly female, younger than 50 years of age, and non-Hispanic white; had some college education; had an annual household income of $50 000 or greater; and resided in a metropolitan area.7Finney Rutten L.J. Blake K.D. Greenberg-Worisek A.J. et al.Online health information seeking among US adults: measuring progress toward a Healthy People 2020 Objective.Public Health Rep. 2019; 134: 617-625Crossref PubMed Scopus (74) Google Scholar On the contrary, a study of patients with macular degeneration, glaucoma, or diabetic retinopathy revealed that characteristics associated with less likelihood to use the Internet included older age, Black race, Hispanic ethnicity, and lower educational attainment.8Stagg B.C. Gupta D. Ehrlich J.R. et al.Evaluation for disparities in experience with internet-based health care among US patients with chronic eye diseases.JAMA Ophthalmol. 2020; 138: 1097-1099Crossref PubMed Scopus (2) Google Scholar Determining the best strategies to educate vulnerable populations and their care professionals about eye health are 2 of the many steps necessary to reduce eye health disparities. The following recommendations may serve as guidelines for patient and physician education. Patient Education1.Keep readability of patient education materials at a fourth- to sixth-grade reading level. Provide in-office education using visual aids, picture-based instructions, and videos.2.Tailor messages toward the intended population. Target individuals at higher risk of ocular disorders and health inequities, including the elderly population, those with diabetes, Blacks, Hispanics, Native Americans, people living in poverty, and residents of medically underserved and rural areas.3.Inform patients about reliable sources of educational materials including online resources and social media.Physician Education1.Educate primary care professionals on the importance of vision screening. Encourage evidence-based and approved consensus-based guidelines for eye exams.2.Develop awareness of eye healthcare disparities among various socioeconomic and cultural backgrounds. Support implicit bias and cultural humility training.3.Promote education in ophthalmology at medical schools and in residency training for family medicine, internal medicine, and pediatric programs.4.Increase research to measure health literacy, identify eye health knowledge gaps, and develop, implement, and evaluate interventions to improve health literacy and vision outcomes.Addressing eye health care disparities requires better dissemination of health information and optimization of health literacy in ophthalmology. The American Academy of Ophthalmology launched a task force to explore health care disparities in ophthalmology, signaling that this issue is a high priority. Reports of this task force will increase awareness of the current situation and serve as a call to action to mitigate health disparities. Patient Education1.Keep readability of patient education materials at a fourth- to sixth-grade reading level. Provide in-office education using visual aids, picture-based instructions, and videos.2.Tailor messages toward the intended population. Target individuals at higher risk of ocular disorders and health inequities, including the elderly population, those with diabetes, Blacks, Hispanics, Native Americans, people living in poverty, and residents of medically underserved and rural areas.3.Inform patients about reliable sources of educational materials including online resources and social media. 1.Keep readability of patient education materials at a fourth- to sixth-grade reading level. Provide in-office education using visual aids, picture-based instructions, and videos.2.Tailor messages toward the intended population. Target individuals at higher risk of ocular disorders and health inequities, including the elderly population, those with diabetes, Blacks, Hispanics, Native Americans, people living in poverty, and residents of medically underserved and rural areas.3.Inform patients about reliable sources of educational materials including online resources and social media. Physician Education1.Educate primary care professionals on the importance of vision screening. Encourage evidence-based and approved consensus-based guidelines for eye exams.2.Develop awareness of eye healthcare disparities among various socioeconomic and cultural backgrounds. Support implicit bias and cultural humility training.3.Promote education in ophthalmology at medical schools and in residency training for family medicine, internal medicine, and pediatric programs.4.Increase research to measure health literacy, identify eye health knowledge gaps, and develop, implement, and evaluate interventions to improve health literacy and vision outcomes.Addressing eye health care disparities requires better dissemination of health information and optimization of health literacy in ophthalmology. The American Academy of Ophthalmology launched a task force to explore health care disparities in ophthalmology, signaling that this issue is a high priority. Reports of this task force will increase awareness of the current situation and serve as a call to action to mitigate health disparities. 1.Educate primary care professionals on the importance of vision screening. Encourage evidence-based and approved consensus-based guidelines for eye exams.2.Develop awareness of eye healthcare disparities among various socioeconomic and cultural backgrounds. Support implicit bias and cultural humility training.3.Promote education in ophthalmology at medical schools and in residency training for family medicine, internal medicine, and pediatric programs.4.Increase research to measure health literacy, identify eye health knowledge gaps, and develop, implement, and evaluate interventions to improve health literacy and vision outcomes. Addressing eye health care disparities requires better dissemination of health information and optimization of health literacy in ophthalmology. The American Academy of Ophthalmology launched a task force to explore health care disparities in ophthalmology, signaling that this issue is a high priority. Reports of this task force will increase awareness of the current situation and serve as a call to action to mitigate health disparities. The Importance of Health Literacy in Addressing Eye Health and Eye Care DisparitiesOphthalmologyVol. 129Issue 10PreviewDisparities in eye health and eye care frequently result from a lack of understanding of ocular diseases and limited use of ophthalmic health services by various populations. The purpose of this article is to describe the principle of health literacy and its central role in enhancing health, and how its absence can result in poorer health outcomes. The article evaluates the current status of health literacy in visual health and disparities that exist among populations. It also explores ways to improve health literacy as a means of reducing disparities in visual health and eye care. Full-Text PDF