Recommended Reading Level for Patient Education Material
Health Literacy: The Gap Between Physicians and Patients
Am Fam Physician. 2005 Aug ane;72(3):463-468.
A more recent article on health literacy is available.
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Article Sections
- Abstract
- Epidemiology
- Bear upon of Inadequate Health Literacy
- Assessing Health Literacy
- Addressing Health Literacy
- References
Wellness literacy is basic reading and numerical skills that allow a person to function in the health care environment. Fifty-fifty though most adults read at an eighth-form level, and twenty percent of the population reads at or beneath a fifth-grade level, about wellness care materials are written at a 10th-grade level. Older patients are peculiarly affected because their reading and comprehension abilities are influenced by their cognition and their vision and hearing status. Inadequate health literacy can result in difficulty accessing health care, post-obit instructions from a doctor, and taking medication properly. Patients with inadequate health literacy are more likely to be hospitalized than patients with adequate skills. Patients understand medical information ameliorate when spoken to slowly, unproblematic words are used, and a restricted corporeality of information is presented. For optimal comprehension and compliance, patient education fabric should be written at a sixth-form or lower reading level, preferably including pictures and illustrations. All patients prefer reading medical data written in clear and concise language. Physicians should be alarm to this trouble considering most patients are unwilling to admit that they have literacy issues.
The American Medical Association (AMA) defines health literacy as "a constellation of skills, including the ability to perform bones reading and numerical tasks required to function in the health care environs."1 Inadequate wellness literacy contributes to poor compliance, uncontrolled chronic disease, and rising health care costs. A recent study past the Agency for Healthcare Research and Quality on health literacy concluded that "depression reading skills and poor health are clearly related."two
Epidemiology
- Abstract
- Epidemiology
- Bear on of Inadequate Wellness Literacy
- Assessing Health Literacy
- Addressing Health Literacy
- References
Almost health care materials are written at a 10th-form level or higher. However, almost adults read betwixt the eighth and ninth grade level.iii Approximately one half of adults are unable to sympathise printed wellness care fabric, and approximately ninety million adults have fair to poor literacy.iii 20-one to 23 pct of adults read at the lowest reading level, approximately fifth-class or lower.3 For patients whose main language is not English, the problem is compounded.4 A survey of patients at 2 hospitals revealed that 35 percent of English-speaking patients and 62 percent of Spanish-speaking patients had fair to poor health literacy.5
The problem of inadequate literacy is greater in older patients. The majority of patients older than 60 years perform at the lowest levels of literacy,half dozen and 80 percent accept limited ability to fill out forms, such as the ones they are asked to complete in md waiting rooms. Ramifications are compounded in older patients because they are more likely to have chronic and comorbid weather condition.
Bear upon of Inadequate Health Literacy
- Abstract
- Epidemiology
- Impact of Inadequate Health Literacy
- Assessing Health Literacy
- Addressing Wellness Literacy
- References
Patients with inadequate health literacy face many obstacles when accessing and using the wellness care organisation. Literacy bug tin can inhibit a patient's power to attend appointments because they may not be able to register for health insurance or follow directions to the physician's role.7 In one case at the office, they may not be able to complete forms proficiently,8 may be aback to ask for assistance in filling out forms, may leave with unanswered questions, or may sign a certificate they accept non understood. Many patients complain that their medico did not explicate their medical status in words they could empathise. Once the date is over, patients with inadequate wellness literacy may not know when to return or how to follow up on the visit.
The majority of patients with literacy problems are unable to follow the prescription directions. "Have 1 tablet X times a day," with the Ten being a number8; the medicine is taken at inappropriate times or intervals, or in the wrong quantities. Patients are more probable to empathize prescription directions, and follow them correctly, when they are written, "Take 1 tablet every 10 hours."
Patients with inadequate health literacy have difficulty controlling chronic illnesses.9After adjusting for sociodemographic and health factors, results of 1 cantankerous-sectional, observational study10 showed that patients with diabetes and inadequate health literacy take poorer glycemic control and higher levels of retinopathy than patients with adequate literacy skills. Patients with asthma and inadequate health literacy do not use their inhalers every bit well as patients with asthma and acceptable literacy skills.eleven
Patients with health literacy problems are less likely to understand and participate in disease prevention and health promotion programs12,13 and are more likely to exist hospitalized than those with acceptable wellness literacy,14 resulting in an additional $69 billion in health care costs annually.4
Assessing Health Literacy
- Abstract
- Epidemiology
- Impact of Inadequate Health Literacy
- Assessing Health Literacy
- Addressing Health Literacy
- References
A grouping of medical residents were asked to place which of their patients had inadequate health literacy. The residents identified 10 percent of their patients, but the bodily figure was more than one third.15 Most physicians who attempt to mensurate the literacy level of their patients make the fault of asking for the highest grade or level of education that they completed. Information technology has been shown that the terminal grade completed often is higher than the actual level of literacy.3 Many high school graduates are illiterate; as historic period increases, so do the deficits in literacy equally a result of declining cognitive function, increased fourth dimension since formal teaching, and decreased sensory abilities. Another common fault is to rely on patients' own cess of their reading skills. The majority of patients who have low health literacy say that they read "well."i
Patients with inadequate wellness literacy oft feel a sense of shame and decreased worth,3 and they may be too embarrassed to ask their physician to explain or echo instructions and other relevant information. Many are so embarrassed by this handicap that they do non tell their spouse.sixteen Behaviors suggestive of limited literacy are listed in Table one.7
Table i
Behaviors Suggestive of Inadequate Health Literacy Skills
| Asking staff for help |
| Bringing forth someone who can read |
| Disability to go on appointments |
| Making excuses ("I forgot my glasses.") |
| Noncompliance with medication |
| Poor adherence to recommended interventions (e.thou., changes to decrease acid reflux, such as elevating the head of the bed) |
| Postponing decision making ("May I accept the instructions home?" or "I'll read through this when I go home.") |
| Watching others (mimicking beliefs) |
Many reading noesis assessment tools are bachelor with which to measure wellness literacy and assess a patient'southward recognition of health care terms4 and their power to interpret written health-related material.17 The Rapid Approximate of Adult Literacy in Medicine is the quickest of these, taking ii to three minutes to complete, and can exist administered by a nurse or other staff member(Figure 1).iv The Test of Functional Wellness Literacy in Adults provides a more thorough picture of the patient's power to comprehend health material, but it is more time consuming and less practical.
Rapid Estimate of Adult Literacy in Medicine
Effigy 1.
Rapid estimate of adult literacy in medicine (REALM).
Reprinted with permission from Health literacy: A prescription to finish defoliation. Establish of Medicine, 2004. Accessed online July 8, 2005, at:http://www. nap.edu/books/0309091179/html/301.html.
Addressing Health Literacy
- Abstract
- Epidemiology
- Impact of Inadequate Wellness Literacy
- Assessing Health Literacy
- Addressing Wellness Literacy
- References
In 1999, the AMA published a report that recommended increasing public awareness, educating the medical customs, and encouraging inquiry on health literacy.1The Joint Committee on Accreditation of Healthcare Organizations has added health literacy benchmarks for hospitals to achieve, and improving health literacy is i of the Healthy People 2010 goals. Nearly recently, the Institute of Medicine of the National Academies added health literacy to its listing of areas for quality improvement.
Physicians need to provide patients with information that is simple and clear to aid them understand their medical condition and its treatment. Many physicians rely on written fabric they transport dwelling with their patients to reinforce or explain further the information discussed during the visit. However, this data often is written at a class level besides high for most patients to empathize. Educational materials should exist short, clear, and simple, and should include pictures.18 One randomized controlled trial19 demonstrated the effectiveness of a low-literacy educational handout in increasing pneumococcal vaccine rates. Simplifying patient pedagogy textile by writing it at a sixth-grade level or lower increases comprehension,4 and patients with adequate literacy prefer to read health information that is written at a lower grade level.19 The focus of the patient education handout should exist on the patient's feel of the condition, rather than the pathophysiology. Presenting too much data on the underlying pathophysiology and using long and complicated words tin subtract a patient'due south understanding of the material.xviii Table ii lists elements found in practiced patient education materials.20
TABLE ii
Elements Constitute in Practiced Patient Education Material
The rightsholder did non grant rights to reproduce this detail in electronic media. For the missing item, see the original impress version of this publication.
When giving information verbally, talking too quickly reduces the hazard that patients will understand what is being said. It is important for physicians to take fourth dimension to enquire their patients to repeat the instructions or otherwise demonstrate their understanding(Table 3).21 Physicians seldom bank check to see if patients understand what happened during these visits.22 A list of Web sites physicians tin can utilise to obtain gratis patient education materials and more than information near health literacy is provided in Tabular array 4. Patients who take the nearly difficulty comprehending health cloth are the least probable to have access to the Internet or know how to use it.
TABLE 3
Six Steps to Enhance Understanding Among Patients with Low Health Literacy
| Slow downward, and have fourth dimension to assess the patients' health literacy skills. |
| Use "living room" language instead of medical terminology. |
| Show or describe pictures to enhance understanding and subsequent recall. |
| Limit information given at each interaction, and repeat instructions. |
| Utilise a "teach back" or "testify me" approach to confirm understanding. This approach involves having physicians take responsibleness for adequate education by asking patients to demonstrate what they accept been told (e.g., echo how to take their medication) to ensure that education has been acceptable. |
| Be respectful, caring, and sensitive, thereby empowering patients to participate in their ain health care. |
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REFERENCES
prove all references
1. Health literacy: report of the Council of Scientific Affairs. Advertizing Hoc Committee on Health Literacy for the Council on Scientific Diplomacy, American Medical Association. JAMA. 1999;281:552–seven. ...
2. Literacy and health outcomes. Bureau for Health-intendance Inquiry and Quality. Prove Report/Technology Cess No. 87, 2004. Accessed online July thirteen, 2005, at:http://www.ahrq.gov/clinic/epcsums/ litsum.htm.
3. Kirsch I, Jungeblut A, Jenkins Fifty, Kolstad A. Adult literacy in America: a start look at the findings of the national adult literacy survey. Washington, D.C.: National Center for Education Statistics, U.S. Department of Pedagogy, 1993. Accessed online July xiii, 2005, at:http://nces.ed.gov/pubs93/93275.pdf.
4. Health literacy: a prescription to end defoliation. Institute of Medicine, 2004. Accessed online July thirteen, 2005, at:http://world wide web.iom.edu/report.asp?id=19723.
5. Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin G, Coates WC, et al. Inadequate functional wellness literacy among patients at two public hospitals. JAMA. 1995;274:1677–82.
6. Literacy of older adults in America. Washington, D.C.: National Center for Education Statistics, U.Southward. Department of Education, 1996. Accessed online July 13, 2005, at:http://nces.ed.gov/pubs97/97576.pdf.
7. Bakery DW, Parker RM, Williams MV, Pitkin Thousand, Parikh NS, Coates W, et al. The health care experience of patients with low literacy. Curvation Fam Med. 1996;5:329–34.
8. Holt GA, Dorcheus L, Hall EL, Beck D, Ellis E, Hough J. Patient interpretation of label instructions. Am Pharm. 1992;NS32:58–62.
nine. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998;158:166–72.
10. Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, et al. Closing the loop: doc communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83–90.
11. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-intendance. Breast. 1998;114:1008–15.
12. Scott TL, Gazmararian JA, Williams MV, Bakery DW. Wellness literacy and preventive health care use amongst Medicare enrollees in a managed care organization. Med Care. 2002;40:395–404.
13. Gazmararian JA, Parker RM, Baker DW. Reading skills and family planning noesis and practices in a low-income managed-care population. Obstet Gynecol. 1999;93:239–44.
fourteen. Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, et al. Functional wellness literacy and the risk of hospital access among Medicare managed care enrollees. Am J Pub Health. 2002;92:1278–83.
15. Bass PF III, Wilson JF, Griffith CH, Barnett DR. Residents' ability to place patients with poor literacy skills. Acad Med. 2002;77:1039–41.
16. Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996;27:33–nine.
17. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med. 1995;ten:537–41.
18. Mayeaux EJ Jr, White potato Pow, Arnold C, Davis TC, Jackson RH, Sentell T. Improving patient pedagogy for patients with depression literacy skills. Am Fam Medico. 1996;53:205–11.
19. Jackson Th, Thomas DM, Morton FJ. Employ of a depression-literary patient education tool to enhance pneumococcal vaccination rates. JAMA. 1999;282:646–50.
twenty. Doak CC, Doak LG, Root JH. Education patients with low literacy skills. 2d ed. Philadelphia: Lippincott, 1995.
21. Williams MV, Davis T, Parker RM, Weiss BD. The office of health literacy in patient-physician communication. Fam Med. 2002;34:383–9.
22. Braddock CH III, Fihn SD, Levinson W, Jonsen AR, Pearlman RA. How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting. J Gen Intern Med. 1997;12:339–45.
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