Claudia K. Nichols

Our healthcare system erroneously assumes a basic foundation of medical understanding by its consumers. Yet the National Assessment of Adult Literacy studies (NAAL) determined that 63 million adults possessed only marginal literacy and 30 million tested below that level.

An unacceptable 36 percent of the population possesses insufficient oral language skills, reasoning ability, arithmetic proficiency, ability to process information, and ability to understand visual tools such as graphs.

Worse, after 11 years there was no progress in improving proficiency levels. Elderly persons, immigrant populations, and those with multiple disabilities were consistently overrepresented.

The results identified the healthcare consumer’s inability to make informed medical choices, according to the paper Patient Advocacy for Health Care Quality: Strategies for Improving Patient-Centered Care. Such learning deficits have grave implications for healthcare efficacy.

There is a high correlation between low literacy and overall health. “Poor health literacy is a stronger predictor of a person’s health than age, income, employment status, education level, and race,” according to the American Medical Association report Health Literacy and Patient Safety: Help Patients Understand.

Treatment compliance and chronic illness management suffer; hospitalizations and expensive medical interventions increase. On an economic level, national productivity is reduced by pain, disability, and increased need for family caregivers, costing the nation up to $240 billion annually, approaching 10 percent of annual healthcare costs.

The intersection of poor health literacy and health is manifold: access to care (procuring insurance, finding and using social safety net programs, locating a doctor, knowing when to seek help); managing illness (understanding and complying with medication and treatment, communicating with clinicians); and distilling information.

Although the causes of low literacy aren’t fully understood, its prevalence and intractability reveal a critical need for advocacy, especially within the medical realm. Indeed, the onus for correcting the imbalance is squarely upon healthcare professionals in their struggle to allocate scarce medical resources, improve care quality, and optimize the overall health of patients.

How to communicate with low literacy individuals is nearly overwhelming. Both educators and patient advocates work to effect change. Strategies include increasing patient engagement, developing awareness and information, assessing an individual’s comprehension to improve one’s understanding, revising document readability, expanding media formats that disseminate information, and identifying non-credible websites on the Internet.

The patient advocate in particular can be a bridge between clinician and patient through improved communication and comprehension skills, raised awareness, accessible information, and publishing research that demonstrates the prevalence and hazards of compromised erudition.

The existing system has the burden of adapting to the needs of all its patients. There are many initiatives to assist with managing poor literacy, including clinician toolkits such as this and this, and for consumers, AskMe3 and advice columns.

Until the U.S. literacy rate is improved, medical providers must assume that every patient, as well as any home or family caregiver, has difficulty understanding — and thus complying with — medical treatment. Sensitivity to communication barriers and proficiency abilities are key to optimal healthcare.

Claudia K. Nichols is a healthcare advocate and Certified Senior Advisor ® (CSA) who founded  Pilot Health Advocates. She currently chairs the Education Committee of the National Association of Healthcare Advocacy Consultants.

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