Health Literacy Improvement Efforts Necessary to Improve Outcomes and Quality

By Jennifer Larson, contributor

January 31, 2012 - It’s easy to make assumptions, such as assuming that one patient understands the directions on his medication bottle, and or that another patient will be able to follow all the discharge instructions that she received when leaving the hospital.

Health Literacy
"The onus is on us to do better," said physician and health literacy expert Ruth Parker, M.D.

But some patients are not be able to do these things. Nearly 80 million people in the United States have basic or below-basic health literacy skills. They don’t have the ability to use healthcare information to make appropriate healthcare choices, which puts them at risk. And, according to physician and health literacy expert Ruth Parker, M.D., that’s a significant problem that must be addressed.

“We really see this as being fundamental to reducing disparities, to reducing costs, to improving quality,” said Parker, a professor of medicine at Emory University School of Medicine and member of the Workgroup on Attributes of a Health Literate Organization of the IOM Roundtable on Health Literacy.

A March 2011 report titled “Health Literacy Interventions and Outcomes: An Updated Systematic Review” found that “differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and among seniors, poorer overall health status and higher mortality.”

According to Parker, health literacy has been an issue that has long concerned some health care experts. And the Institute of Medicine’s roundtable has gathered participants from a variety of disciplines to discuss possible solutions for at least a half-decade.

Their efforts recently got a significant boost.

An article titled “New Federal Policy Initiatives to Boost Health Literacy Can Help the Nation Move Beyond the Cycle of Costly ‘Crisis Care,’” appearing in the February issue of Health Affairs, highlights the issue. It noted that three major federal policy initiatives in 2010 addressed the need to promote health literacy in the United States:

• The Affordable Care Act, which  addresses the issue of health literacy as an important factor in providing more accessible health care,
• The U.S. Department of Health and Human Services’ National Action Plan to Improve Health Literacy, which sets out goals and strategies for boosting health literacy, and
• The Plain Writing Act of 2010, which requires federal agencies to use clear, easily understandable language.

The authors of the Health Affairs study, who include such high-profile individuals as Assistant Health and Human Services Secretary Howard Koh, AHRQ Director Carolyn Clancy, and CDC health literacy expert Cynthia Baur, also cited the Healthy People 2020 initiative, which includes health literacy-related objectives.

“The federal initiatives of the past few years, combined with a growing commitment to encouraging health-literate organizations and system change, can help the nation tackle health literacy and ultimately help us all lead longer, healthier lives,” the authors wrote.

This high profile acknowledgement of the problem is welcome because it gives even more weight to the issue, Parker said.

“The opportunity is there,” she said.

“Hopefully the movement will catch fire and people will understand the importance,” said surgeon Steve Pu, D.O., chairman of the board of directors of Health Literacy Missouri, a nonprofit founded by the Missouri Foundation for Health.

Taking the next step

The need to improve health literacy seems to be growing more urgent. As the health care system grows increasing complex, it becomes increasingly difficult for many people to navigate, noted clinical dietitian Victoria H. Hawk, MPH, RD.

Plus, it’s not always obvious to healthcare providers who may have a low level of health literacy.

“Everyone is at risk because all people may have difficulty understanding some information some of the time,” said Hawk, a member of a team from the University of North Carolina at Chapel Hill that developed the Health Literacy Universal Precautions Toolkit for the Agency for Healthcare Research and Quality. 

To take awareness of the need to the next level, organizations must step up and “make promoting health literacy an organizational responsibility and prepare their employees to meet it,” commented the Health Affairs study authors.

According to Parker, that will take committed leadership from the top. If leaders show that they are committed to boosting health literacy, they can show everyone else in the organization that it’s a priority--a priority that will remain on the agenda.

“It has to be reflected in policy so it is truly woven throughout the organization,” Parker said, adding that it would also be useful to have a metric for measuring the results because, “What gets measured gets done.”

Training must also be on the agenda. For example, Health Literacy Missouri is working to train health care professionals around the state in communication techniques such as the Teach-back Method, which will help providers assess how well their patients understand by having them describe what they think they are supposed to do.

The organization also hopes to work with medical and pharmacy schools to incorporate health literacy training into their curricula, Pu said. Additionally, there are a couple of promising pilot projects getting underway.

Resources available

There are now a variety of resources available to help healthcare organizations determine how they can best improve their communication techniques and boost the health literacy levels of the people they serve. In addition to resources offered by the Centers for Disease Control and Prevention and the Health Resources and Services Administration, many professional associations such as the American Medical Association have launched health literacy initiatives.

Another resource for primary care practices that want to improve the care they provide by instituting clear communication techniques is AHRQ’s Health Literacy Universal Precautions Toolkit.

“The toolkit recommends a universal precautions approach to health literacy which assumes that everyone will have difficulty,” said Hawk. “And thus, rather than testing patients, it encourages a practice to establish and implement systems that will help everyone regardless of their literacy level.” 

Hawk noted that the team recommends that an organization start out by choosing someone to lead the effort. But it’s important to get everyone on board to support it. “This type of change requires the support of more than one person,” she said.

Related reading:

Attributes of a Health Literate Organization,” a new discussion paper released by workgroup participants of the IOM Roundtable on Health Literacy.

Health Literacy Universal Precautions Toolkit by AHRQ.

New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly ‘Crisis Care’” in Health Affairs.