Reduced health literacy affects nearly 9 out of 10 adults and significantly impacts individuals and the nation's economy.
Personal health literacy is "the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others." Anyone who uses an over-the-counter medicine, visits a medical provider, reads health information online, or even joins a gym is making a health decision. Limited health literacy hampers our ability to understand the complexities and consequences of everyday decisions about health and lifestyle. Someone with low health literacy can unknowingly make a decision that adversely impacts their future health.
Low health literacy consistently leads to poorer overall health and quality of life. And, it’s linked to higher healthcare costs. According to the Centers for Disease Control and Prevention (CDC), people with low health literacy are less likely to follow treatment plans. Therefore, they have increased emergency room visits, more (and longer) hospital stays, increased risk and mismanagement of chronic disease, and higher death rates. In 2003, the U.S. Department of Education's National Assessment of Adult Literacy reported low health literacy costs the U.S. economy between $106 billion and $238 billion annually. If we factor in inflation, that cost reaches $234 billion to $384 billion in 2022’s economy.
What are the real-world implications of ignoring health literacy? Look at the far-reaching impact of COVID-19. New data from the CDC's Household Pulse Survey shows that approximately 40% of adults in the U.S. reported having contracted the COVID-19 virus at some point. Between the lives lost and the long-lasting economic damages, COVID-19 carried an enormous price tag.
And while the COVID-19 pandemic affected people worldwide, it also brought a new awareness of the importance of health education and health literacy in communicating health risks, encouraging healthy behaviors, and ultimately improving people’s health and well-being.
Addressing Health Literacy Before It’s a Barrier to Care
Here are three ways health and wellness professionals can prepare for low health literacy and help mitigate its impact.
1. Assume everyone struggles with health literacy.
As the saying goes, you can't tell a book by its cover. You don't know by looking at a person if they have reduced health literacy. Anyone can struggle with it: Rich or poor, young or old, high school dropout or university professor. While many people with low education levels have low literacy, remember that health literacy requires more than being able to score well on the SATs or solve calculus equations.
The CDC indicates that people can face health literacy issues when:
- They aren't familiar with medical terms or how their bodies work.
- They must interpret statistics and evaluate risks and benefits affecting their health and safety.
- They are diagnosed with a serious illness and are scared and confused.
- They have health conditions that require complicated self-care.
- They are voting on an issue affecting the community's health and relying on unfamiliar technical information.
An individual's health status, stress level, and social status contribute to health literacy. The Agency for Healthcare Research and Quality (AHRQ) produced a multi-question patient health literacy survey that can be adapted for use in other health and lifestyle settings. Understanding that health literacy issues impact everyone can help you reframe communications to be clear, direct, and relatable.
2. Dig into your data
Your data can give clues about the health literacy of individuals within your population. Are they comfortable communicating in English? How healthy are their lifestyle habits? Do they take medicines as prescribed and adhere to recommended lifestyle changes? An individual might not understand directions enough to follow them, or they may forget health information shortly after the appointment. The teach-back method can help health and wellness professionals check whether an individual understands and can follow advice.
"Studies have shown that 40-80% of the medical information patients are told during office visits is forgotten immediately, and nearly half of the information retained is incorrect."
And don’t forget about the way you are communicating as a factor— in person or through technology. According to doctors Norman and Skinner, eHealth literacy requires a different skill set. "At its heart are six core skills (or literacies): traditional literacy, health literacy, information literacy, scientific literacy, media literacy, and computer literacy."
An individual might understand face-to-face counsel yet can’t connect with digital follow-up. If you want individuals to sign onto a portal, take a health risk assessment, or connect with an intervention via a smartphone, make sure they can complete forms and assessments online. If not, offer assistance or deliver the assessment or information in an alternative format. For example, you could administer the assessment online, on paper, or over the telephone.
3. Have a plan
Public health professionals, first responders, and other emergency personnel work hard to strengthen their emergency preparedness plans—because preparedness saves lives. Population health and wellness managers are on the front lines of the health literacy epidemic. Accrediting agencies, such as the National Committee for Quality Assurance (NCQA) and the Joint Commission, recognize the importance of planning for reduced health literacy and place the onus of understandability on health and wellness providers. Most U.S. states have literacy standards in place for Medicaid. Still, it's important to remember that reduced health literacy impacts most Americans—not just Medicaid populations. Although written for primary care practices, AHRQ's Health Literacy Universal Precautions Toolkit has helpful information that population health and wellness professionals can use to enhance their communication efforts.
For more health literacy resources and tips to improve your communications around health and well-being, download our Health Literacy Guide.