Provider perceptions of health literacy in an urban community

Abstract

Objective: To gain an understanding of health and social service providers' perceptions of the scope and nature of health literacy problems in an urban setting. Design: Qualitative study. Setting: Representatives of 13 local health care organizations, churches, and community-based organizations participated. Method: Representatives were placed in two focus group sessions and responded to questions regarding their assessment of the nature and scope of health literacy problems in the community and the multidimensional strategies required to improve health literacy among underserved populations. Results: Participants reported that approximately 30 to 80 percent of their clients/patients had low health literacy skills. They also reported that individuals with low literacy skills are often reluctant to self-disclose their inability to read or understand health information, have problems understanding food labels and medication dosage instructions, and do not know how to advocate for themselves. The participants highlighted the need for physicians, nurses, social workers, health care administrators and other health professions to adopt a multi-dimensional approach to address the needs of individuals with low literacy skills and to empower them to use available community resources such as language interpretation services. Low health literacy is common among Americans (Agency for Healthcare Research and Quality, 2004). Health literacy has been de ned as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (National Library of Medicine, 2000). In April of 2004, the Institute of Medicine (IOM) released a report titled, “Health Literacy: A Prescription to End Confusion.” The report showed that low health literacy adds as much as $58 billion a year to health care and people of all ages, races, incomes and education levels are challenged by low health literacy (Agency for Healthcare Research and Quality, 2004). Approximately 90 million adults in the United States scored on the two lowest levels of the five levels of the National Adult Literacy Survey (Agency for Healthcare Research and Quality, 2004). These levels are associated with having trouble finding pieces of information or numbers in lengthy text, integrating multiple pieces of information in a document, finding two or more numbers in a chart, and performing a calculation (Kirsch, Jungeblut and et al., 2002). Low health literacy has been associated with poorer knowledge about health conditions (Kalichman & Rompa, 2000), lower use of preventive services (Scott, Gazmararian and et al., 2002), higher rates of medication non-adherence (Kalichman, Ramachandra, & et al., 1999), high hospitalization rates (Baker, Parker and et al., 1998), (Baker, Parker and et al., 1997), poorer self-reported health, (U.S. Census Bureau, 2000), low utilization of potentially life-saving screening, poor patient- physician communication) inability to understand prescriptions, instructions and consent forms, low participation in health promotion and disease prevention activities, inability to understand and use information on food labels, poor self-management of chronic diseases, (Institute of Medicine, 2004), poor use of health care services, (Davis, Fredrickson and et al., 1998a) and negative health outcomes (Davis, Fredrickson and et al., 1998a). Most studies that have examined some of the barriers to improving health literacy skills have focused on the readability levels of health education materials (Dowe, Lawrence and et al, 1997), (Ley, Jain and et al., 1976), (Jolly, Scott and et al., 1995), (Sumner, 1991) (Davis, Fredrickson and et al., 1998a). For instance, one study involved matching the reading level of health materials with the reading ability of the patients using a randomized approach (Dowe, Lawrence and et al., 1997). One of the results of this study indicated that patients with low health literacy levels who received less complex health materials were more likely to read the leaflets than those who received more complex materials. However, changing the reading level of health materials alone will not be sufficient for helping to improve health literacy levels and outcomes. Plimpton and Root argue that the sole strategy of improving the readability of health materials falls short of addressing the needs of individuals with low health literacy skills and instead tends to benefit those with higher health literacy skills (Plimpton and Root, 1994).