Strategies to Address Low Health Literacy and Numeracy in Diabetes

Abstract

H ealth literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.”1 Health literacy is involved in performing most health care tasks, including, for example, finding the Ophthalmology Department to get an eye exam, communicating effectively with health care providers, and filling out medical and insurance forms to receive health care services. A growing body of evidence shows that, compared to those with adequate health literacy, individuals with low health literacy are more likely to inappropriately or infrequently use health care services,2,3 face difficulty following medical instructions,4–6 have worse physical and mental health,7 and have a shorter life expectancy.8 Health literacy encompasses a variety of skills beyond reading and writing (also called print literacy).1,9 It includes speaking and listening (also called oral literacy), cultural and conceptual knowledge, and the ability to apply numbers as needed to manage one's health (also known as quantitative literacy or numeracy).9,10 Recent studies have found the latter to be an important independent predictor of health behaviors and outcomes.10 And although health literacy and numeracy are often related,11 we find many patients with adequate health literacy who lack basic numerical abilities.12 The impact of patient health literacy and numeracy on self-care activities and health outcomes may vary according to the requisite skills needed to manage one's health in a given context.13–18 Low health literacy and numeracy are prevalent, affecting approximately one in three adult Americans.11 They are associated with poor health outcomes across chronic disease contexts.19 In diabetes, patients with low health literacy have greater difficulty understanding their disease,20,21 participate less in self-care activities, …