Agency for Healthcare Research and Quality
Everyone is at risk of being illiterate when it comes to their own health care, especially when they are sick, frightened, conflicted or overwhelmed with new information – and often too embarrassed to admit it.
Yet, research shows that literacy skills are the strongest predictor of a person’s health status.
“To improve health care outcomes it is imperative to structure and deliver care as if everyone may have limited literacy because at some point in their lives they probably will,” said Cindy Brach, senior health policy researcher at the Agency for Healthcare Research and Quality.
“Everyone benefits from clear communication, and everyone is at risk for misunderstanding,” Brach told nurses, public health workers, doctors, social workers and medical students attending a recent symposium at the University of North Texas Health Science Center that focused on how to make health care services safer and improve quality.
Health care literacy is the ability to obtain, process and understand basic health care information and services needed to make appropriate health decisions. It includes not just the ability to read, but also the ability to understand written and communications, numbers and math.
Communication problems are the most common cause of medical errors, and medical errors are now the third leading cause of death in this country, Teresa Wagner, an advocate for health literacy, said at the conference.
“Miscommunication is the leading cause of patient dissatisfaction with health care,” Wagner said. “Patients who miss appointments may have a liable lawsuit if they can prove it was due to a doctor’s unclear, inadequate or questionable instructions.”
Wagner is director of health literacy for the Literacy Coalition of Central Texas and spoke on health literacy in Texas and best practices to improve provider-patient communications.
“We need a health-literate state. We need to get Texas to where other states are,” she said.
Legislation requiring transparent, easy-to-understand information about cost, quality and treatment options was introduced but never got out of committee during the last session of the Legislature because it was not a priority, Wagner said.
Most health care information is written at the 10th grade reading level or higher, but the average adult in the United States reads at the eighth grade level.
Twenty percent of the general population, including 40 percent of older residents, read at the fifth grade level or lower, one speaker noted at the conference, which was cosponsored by the United Way of Tarrant County and its Area Agency on Aging and Methodist Healthcare Ministries of South Texas Inc.
Two-thirds of Texas residents have only a basic or below basic understanding of the information they receive from their health care providers. That makes them less likely to get preventive care, less likely to keep diabetes well-controlled and more likely to use emergency rooms and require hospitalization, Wagner said.
“The American Medical Association has found that poor health literacy is a stronger predictor of a person’s health status than age, income, employment status, educational level or race,” she said.
Overall 43 percent of patients cannot understand the things their health care providers ask them to do, and you can’t tell by looking which patients they are.
Stress and shame complicate the picture.
“Stress impacts receptivity. When people are under enough stress, nine out of ten of them may lack the knowledge and skill needed to manage their health and prevent disease,” Wagner said.
And there is a stigma attached to not understanding that often keeps patients from admitting they do not understand and from asking about things they fear they should already know.
“Is it any wonder that patients are confused and don’t follow up?” she asked.