Fighting the Epidemic: How to Combat Health Illiteracy 
The instructions on the side of the small orange prescription bottle may seem simple: “Take two tablets by mouth twice daily.” But some patients may not be able to read the directions at all; others might struggle to interpret them. Should they take two pills total or two at breakfast and another two before bed? October is Health Literacy month, a time to focus on continually improving the way hospitals and health care providers craft their messages and communicate with patients.

The National Assessment of Adult Literacy reports that nine out of 10 adults may lack the language skills needed to manage their health and prevent disease. The ability to read, understand and act on health information is all part of health literacy. It is not just about being able to read, but being able to comprehend and act on complex information. Most health materials are written at or above a 10^th grade reading level, while reading materials for a general audience should be written at a 4^th to 6^th grade reading level, according to the U.S. National Library of Medicine and the National Institutes of Health. Particularly vulnerable to health illiteracy and its consequences are older adults, minority populations and those who are poor and medically underserved. Though certain populations are at a heightened risk, not every adult struggling to manage his or her health fits these common profiles. Any patient can struggle with medical jargon and confusing forms.

Health illiteracy is not without a cost to patients’ health and both patient and hospital pocketbooks. Low health literacy leads to less healthy behaviors, which result in poorer health outcomes and greater health costs. A 2004 study commissioned by the Institute of Medicine found that the U.S. health care system spends an average of $993 every year in excess hospitalization expenses for every patient with inadequate health literacy. This accounts for tens of billions of dollars in annual health care costs.

Health illiteracy takes a considerable toll on peoples’ health. In fact, literacy is considered the best predictor of health status – better than age, income, employment status, educational level, or racial and ethnic group – according to the Partnership for Clear Health Communication, a coalition of 19 of the nation's top health and civic organizations. A study released in July 2007 of patients 65 years and older determined those who couldn’t understand basic written medical instructions were much more likely to die within six years than those who understood the information.¹ Effectively communicating with people at their literacy levels, or even just simplifying medical terminology, may help patients live longer, healthier lives with fewer and more affordable trips to the hospital.

When caregivers are interacting with patients, giving specific instructions, breaking down complex directions and steering away from difficult words are key tactics in decoding complicated information. Literacy levels vary by community and to more accurately gauge reading levels, hospital practitioners also can conduct research. A demographic profile and a literacy audit can provide effective initial looks into the community and identify the reading level that directions, forms, information and instructions should be geared toward. But even without a formal study, easy steps such as changing materials to a simple writing style with bullets, active voice, concrete examples and context can improve patients’ comprehension. To raise literacy awareness in a community, The Health Literacy Month Web site provides examples of activities such as health conferences for providers, consumer health programs for patients and families, research about ways to improve health communication and easier-to-read booklets and other teaching materials.

The Ohio Patient Safety Institute (OPSI) has recognized health literacy as a significant cause of medication errors for many years. To facilitate communication between the consumer and health care professionals, OPSI developed, in conjunction with health literacy groups, a medication brochure in 2002. This brochure, available in English or Spanish and in a low literacy version, is accessible at www.ohiopatientsafety.org.

The battle for improved health literacy may be fought on the front line by the health care professionals who interact one-on-one with patients, but support from hospital leadership is a deciding factor in winning the war against health illiteracy. The U.S. Department of Health & Human Services’ Office of Disease Prevention and Health Promotion provides a sample action plan for national, state, county and community health organizations focused around priorities with action steps and objectives to help evaluate progress. Building a case for change begins with educating decision-makers to create policies and procedures to improve health literacy.

The face of health illiteracy is not always predictable. It may be hard to spot a patient with limited reading skills, and even the most educated patients may struggle over complex information and be too embarrassed to ask questions. October, Health Literacy Month, provides an ideal platform for health literacy initiatives and a renewed effort to tackle health illiteracy. A concerted effort to shape materials and communications to effectively reach all patients can improve health, cut costs and even save lives.

¹ http://archinte.ama-assn.org/cgi/content/short/167/14/1503

Ohio Patient Safety Institute provides a medication safety brochure for a low literacy audience.



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