Oral health literacy: correcting the mismatch

Abstract

Any unnecessary death and most especially the death of a child in an industrialized society such as ours with the means to prevent the cause of death, to intervene early, and treat even late symptoms, is not simply tragic but criminal. Horowitz and Kleinman insist that we learn from the untimely death of Deamonte Driver and take action. Horowitz and Kleinman review steps being taken in Maryland and suggest that attention to health literacy – and, in this important case, to oral health literacy, will enable us to avoid such events and serve to reduce health disparities in the future. They rightly point to the accumulated evidence that close to a majorityof USadultshave limited literacyskillsandthatasubstantial body of research indicates that those with poor literacy skills are likely to experience untoward health outcomes. We know, for example, that those with limited literacy are less likelytoengageinpreventiveaction,toengageinscreeningand treatment, and to manage a chronic disease well. The publication of findings from the adult literacy surveys conducted first in 1992 and again in 2003 spurred this interest in the possible health effects of the poor literacy skills. However, educators remind us that literacy does not exist in a vacuum. For example, assessments of reading skills must also consider the difficulty of the text; similarly, measures of listening skills must appraise the spoken word and its delivery. Thus, we cannot assess people’s ability to access oral health information if the messages are not provided or filled with jargon. We cannot assess someone’s reading skills based on health materials that are poorly written. Attention cannot be entirely focused on the skills or deficits of the public. Instead, we must focus attention on the abilities of health and social service professionals to communicate with the public, to identify and remove literacy-related barriers to information, decision making, and healthful action. Furthermore, we must change those features of our health systems that hinder access to information and care. Horowitz and Kleinman avoid the errors perpetuated in the early health literacy studies and editorials that evidenced a somewhat myopic focus on deficits of patients. In contrast, Horowitz and Kleinman correctly point out that action must also be taken to enhance the oral health literacy and communication skills of professionals. They note that the 2007 Maryland Dental Action Committee Report calls for educating parents, caregivers, and health professionals about oral health. Horowitz and Kleinman are establishing baseline data of knowledge and understanding, practices and techniques, and skills of the lay public, as well as of social service and health professionals. In so doing, they present a balanced approach for oral health literacy that practitioners and policy makers must emulate. We need to pay attention to the mismatch between what we now know are average literacy skills of US adults and the burdensome demands of messages, directions, and information that are not easily understood or accessible.