Volume 56, Number 3 - Summer 2010

 

By Irina deFischer, MD

What is health literacy and why is it important? Health literacy is an individual’s ability to read, understand, and use health care information to make decisions and follow instructions for treatment. It includes a wide range of skills and competencies that people develop over their lifetimes to seek out, comprehend, evaluate and use health information. Developing health literacy allows us to make informed choices, reduce health risks, and increase quality of life. 

A mismatch between clinicians’ level of communication and patients’ ability to understand can lead to medical errors and adverse medical outcomes. Certain groups—such as the elderly, ethnic minorities, recent immigrants and people with low general literacy—often have low health literacy. However, even well-educated people can also have difficulty understanding scientific jargon. A colleague recently diagnosed with prostate cancer, for example, confessed that he signed the surgical consent without fully understanding it because he felt it was necessary to his survival. My highly intelligent and well-educated father is at a loss when asked to pass along reports of our relatives’ health problems because, he says, “I’m not a medical doctor.”

On the other hand, a good friend of mine, a librarian who developed a rare form of lung cancer in her late 40s, used her research skills and computer literacy not only to learn as much as possible about her disease, but also to draw on the support of an online community of fellow patients. These efforts were a tremendous source of empowerment for her, helping her regain a sense of control in the face of a devastating diagnosis. 

Health literacy can prevent medical errors, as I know from first-hand experience. At the end of my second pregnancy, I checked into the labor and delivery unit of our local hospital in active labor and three days past my due date. I was trying to relax to the sounds of Mozart’s clarinet concerto when a nurse arrived with an IV pole. 

“Why do I need an IV?” I asked.

“Well, dear, I need to give you a tocolytic to stop your contractions!”

“Oh no, you don’t,” I exclaimed. “This baby’s coming today!” The error was averted, and my son Marc was born an hour later. 

We as physicians ignore health literacy when we fail to clearly explain health issues to our patients and the public. We can avoid this error by providing simplified information with illustrations and avoiding the use of jargon. Other techniques include asking patients to repeat back instructions and encouraging them to ask questions, as well as providing audio and video materials in the office or online. 

The team-based approach can be invaluable in assessing patients’ health literacy and reinforcing patient information. Such an approach can start with asking front office staff to administer a brief questionnaire, in which patients are asked to read a nutrition label (see figure) and answer six questions about the label (see below). 

Question 5 is of particular interest: “Pretend that you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee stings. Is it safe for you to eat this ice cream?”

How well can your patients answer that question?