When Jonathan J. Beitler, MD, met with a patient who had been disabled by a recent stroke, he was surprised by the man’s initial interaction. “His first words to me were, ‘I don’t like doctors,’” said Dr. Beitler, an oncologist at Emory University’s Winship Cancer Institute in Atlanta. “I said, ‘Neither do I,’ and we did much better after that. But because the patient had poor medical literacy, he focused on the attitude of those taking care of him and focused on emotions rather than objectively looking at what his health care problem was and how best to deal with it.”
Explore this issue:September 2012
Dr. Beitler, the lead author of a 2010 American Journal of Otolaryngology study on health literacy among laryngectomy patients, found that patients considered to have low health literacy levels were also less likely to have access to health care and, subsequently, were less likely to make informed choices about their health (J Otolaryngol. 2012;31;29-31). “People who are health care illiterate seem to make their decisions based on emotions and transportation barriers (often influenced by the weather), as well as their resources,” he said. “Facts and objective needs are way down on their list of considerations.”
Luckily, Dr. Beitler’s patient had a devoted friend who could drive him to follow-up appointments and a highly supportive wife at home. Such allies, along with a strong doctor-patient relationship, ultimately helped the patient achieve an optimal outcome.
Health Literacy: What It Is
Health literacy is the ability to comprehend and use medical information and services so that patients can follow treatment instructions and make informed choices about their health. According to the American Medical Association’s manual on health literacy, Health Literacy and Patients’ Safety: Help Patients Understand, “clinicians can most readily improve what patients know about their health care by confirming that patients understand what they need to know and by adopting a more patient-friendly communication style that encourages questions.”
Several factors influence whether a patient has high, moderate or low health literacy, said Helen Osborne, MEd, OTR/L, a health literacy expert and the president of Health Literacy Consulting in Natick, Mass. “People struggle because of age, language, disability (including hearing loss), culture and emotion,” she said. “Low health literacy is not synonymous with low literacy.”
There are varying degrees of health literacy as well, according to a U.S. Department of Education report, “The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy.” The report, updated every 10 years, assessed how well more than 19,000 adults performed certain tasks such as circling an appointment date on a piece of paper from a hospital visit or understanding the healthy weight range on a body mass index chart. The report grouped health literacy results into four categories: below basic, basic, intermediate and proficient. While 53 percent of adults showed intermediate health literacy, indicating they could understand moderately challenging material, 36 percent tested at basic or below basic levels. This means that approximately one in three adults could only process simple health-related material or could not understand it at all.