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August 2, 2018 | Author: Anonymous | Category: N/A
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Doctor-Patient Relationships : Understanding the Importance of Health Literacy in Patient Care Jennifer Hensley, MD Catherine Nicastri, MD

State University of New York, Stony Brook Department of Medicine, Division of Geriatrics

Can you read this?

Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

How many adult Americans have difficulty reading and understanding health information? A. 9


B. 90


C. 50


D. Fewer

than 1 million

Definition of Health Literacy 

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

It involves the ability to use and interpret text, documents and numbers effectively

The Scope of Low Health Literacy 

In 2003, the National Assessment of Adult Literacy (NAAL) 

90 million Americans (39% of adults) have limited health literacy

One in five adults read at the 5th grade level or below.

Average American reads at the 8th to 9th grade level

More than 66% of US adults age 60 and over have inadequate or marginal literacy skills

Examples of Health Literacy Tasks 

Proficient Skills: 13% 

Intermediate Skills: 53% 

Determine timing, administration and interactions based on info from drug label

Basic Skills: 22% 

`Calculate employee’s share of health insurance cost for year using a table on monthly cost

Give 2 reasons why a person with no symptoms should be screened based on a clearly written pamphlet

Below basic skills: 14% 

Circle date of medical appointment on hospital appointment slip

Who is at risk for low health literacy? A.



Ethnic Minorities


Those with low income and education levels


Those with high income and education


A, B, and C


All of the above

Highest Risk for Limited Health Literacy 


Low income


Did not finish high school

Minority ethnic group (Hispanic, African American)

Recent immigrant to US who does not speak english

Born in US but English is 2nd language

Health System Problems Encountered by Persons with Limited Literacy Skills  26%

Did not understand when their next appointment was scheduled

 42%

Did not understand instructions: “take medication on an empty stomach”

 78%

Misinterpret warnings on prescription


 86%

Could not understand rights and responsibilities section of a medicaid application

Impact of Low Health Literacy 

Individuals have less knowledge about their health problems

Make more medication or treatment errors

Fail to seek preventive care

More hospitalizations

Higher health care costs

Less able to “comply” with treatments

Poorer health status

Shame and Health Literacy: the unspoken connection Adequate Health Literacy 

49% Feel bad/never

Low Health Literacy 


51% Feel bad/never tell

60% Feel ashamed

60% Feel ashamed

94% Hide problem

78% Hide problem

"Shame and Health Literacy: The Unspoken Connection." Patient Education and Counseling. 1996. 27: 33-39

Who knows you have trouble reading? Never told: 







Co- workers




No one


"Shame and Health Literacy: The Unspoken Connection." Patient Education and Counselling. 1996. 27: 33-39

Physician Assessment of Health Literacy 

Physicians often under recognize limited health literacy 

Most physicians’ attempt to measure literacy level by their patients highest grade of education Rely on their patients’ own assessment of their reading skills

Overestimate their patients ability to understand medical information

Often provide information to patients in a level of complexity that patients do not understand

What can we do? 

Recognize signs of limited health literacy

Screen for health literacy

Learn clear communication techniques

Educate patients on AskMe-3

Ms Kelly Green

Ms Kelly Green is a 54 year old caregiver to her mother who is bringing her to your office for a follow up visit. Her mom has history of dementia, hypertension, hypothyroidism and arthritis. She was just discharged from the hospital for Uncontrolled Hypertension.


Office Visit

Did Ms. Green give any clues that she may have limited health literacy?

Signs (Clues) of Low Health Literacy Behaviors 

Forms incomplete or inaccurately completed

Frequently missed appointments

“Noncompliance” with medication regimens

Lack of follow-up with lab tests, imaging or referrals

Responses to written information 

“I forgot my glasses. I’ll read this when I get home.”

“I forgot my glasses. Can you read this to me?”

“Let me bring this home so I can discuss it with my children”

Responses to questions about medications 

Unable to name medications

Unable to explain what the meds are for

Unable to explain timing of medication administration

If you suspect Ms. Green’s health literacy is limited what screening tests could you perform?

Quick Screening Tests for Health Literacy

Single question screens

Assessment instruments 

REALM-R: Rapid Estimate of Adult Literacy in Medicine-Revised

NVS: The Newest Vital Sign

Single Question Screens 

“How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?” Never




“How confident are you filling out medical forms by yourself?” Extremely


Quite a bit


A little bit

Not at all

Both been validated in English

The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. BMC Fam Prac. 2006;7:21. Screening items to identify patients with limited health literacy skills. J Gen Intern Med. 2006;21:874-877


Word recognition test consisting of 11 medical terms

1st 3 words are not scored (fat, flu, pill): left to decrease test anxiety and enhance patient confidence

Administration time:
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