Health Literacy: A New Challenge for Health Care Providers
Jane McCall MSN, RN; Carol Wilson BSN, RN
What is health literacy?
Results of our survey
Ability of an individual to access, understand, evaluate, and communicate information as a way to promote, maintain and improve health in a variety of settings across a lifetime.
Results of our survey Health Literacy Screening:
Participant Composition Visitors, 4
• • • •
Surgical, 8 HIV/AIDs in-patient, 19
Why is it important?
Off service in-patient, 2
Patients need adequate health literacy to:
Access the Health Care System − directions and appointments − medical forms and pharmacy prescriptions
Understand Health Related Information − read, interpret, listen, and act
Evaluate Health Related Information − monitor and follow treatments Communicate about Health − learn, understand, ask, and educate
HIV Out-patient Clinic, 83
What did we do?
We asked patients to answer four screening questions to assess their perceived ability of understanding medical terms, understanding written information, confidence in filling in medical forms on their own, and reading pamphlets, instructions or other written material without help. We also got them to complete the Newest Vital Sign. The Newest Vital Sign is a nutritional label. Patients are asked six questions related to the label. The questions require them to critically think about what is on the label and how it applies, using the same skills needed to understand medical information (reading, understanding, navigating, calculating, problem-solving).
42% need someone to help them read and understand medical instructions
57% answered 3 or less questions correctly indicating they are at risk for limited health literacy
30 25 20 15
We cannot assume education level or self-perceived ability as accurate identifiers of limited health literacy. While patients generally felt they had the skills, the number who actually were challenged is consistent with research conducted by the Canadian Council on Learning; that an estimated 60% of Canadian adults have limited health literacy. (Health Literacy in Canada: A Healthy Understanding 2008; Ottawa: 2008)
Some high school
High school graduate
Score Sheet for the Newest Vital Sign Questions and Answers READ TO SUBJECT: This information is on the back of a container of a point of ice cream.
1. If you eat the entire container, how many calories will you eat? Answer: 1,000 is the only correct answer 2. If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream could you have? Answer: Any of the following is correct: 1 cup (or any amount up to 1 cup), half the container. Note: If patient answers “two servings,” ask “How much ice cream would that be if you were to measure it into a bowl?”
45% do not feel confident filling out medical forms
Education Levels of Participants
People living with HIV have similar health literacy levels to the general population. Low health literacy is associated with non-adherence to HAART and a poor understanding of the HIV disease process. In one study, 53% of person who had low health literacy were identified as having adequate health literacy by their providers (Ohl et al, AIDS Patient Care and STDs, 2010, 24(10)).
37% have problems understanding written information
Newest Vital Sign:
HIV and Health Literacy
41% said we use terms that are hard to understand
3. Your doctor advises you to reduce the amount of saturated fat in your diet. You usually have 42 g of saturated fat each day, which includes one serving of ice cream. If you stop eating ice cream, how many grams of saturated fat would you be consuming each day? Answer: 33 is the only correct answer 4. If you usually eat 2,500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one serving? Answer: 10% is the only correct answer READ TO SUBJECT: Pretend that you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee stings. 5. Is it safe for you to eat this ice cream? Answer: No 6. (Ask only if the patient responds “no” to question 5): Why not? Answer: Because it has peanut oil. Number of correct answers:
Interpretation Score of 0-1 suggests high likelihood (50% or more) of limited literacy. Score of 2-3 indicates the possibility of limited literacy. Score of 4-6 almost always indicates adequate literacy.
Weiss, B. D, et al. Quick Assessment of Literacy in Primary Care: The Newest Vital Sign. Annals of Family Medicine 2005; 3:514-522.
Developed a pilot program to improve the health professional’s ability to communicate so patients can understand and act on information:
• • • • •
Assume everyone has limited health literacy Create a shame-free environment Speak in clear language Encourage questions Use teach-back to check understanding
Sustain the practice through personal action plans, self-assessment tools, and follow-up as part of practice and performance review.