In 1993 to mid-1995, researchers at Emory University School of Medicine assessed the prevalence of inadequate health literacy among patients presenting for outpatient acute care in two urban public hospitals, one in Atlanta and one in Los Angeles.

They developed a valid and reliable research instrument, the Test of Functional Health Literacy in Adults, and administered it in both Spanish and English versions.

Key Findings

• More than 35 percent of English-speaking and 61 percent of Spanish-speaking patients were found to have inadequate or marginal functional health literacy.
• The problem was especially prevalent among the elderly.
• Patients with inadequate functional health literacy:
  • Were almost twice as likely to report their health as poor than were those with adequate health literacy.
  • Were more likely than literate patients to misunderstand medication instructions and return appointments.
  • Had difficulty navigating to and within the hospital and understanding informed consent.
  • Were likely to feel shame about their inability to read.
• Language barriers may be as important as reading difficulties for Spanish-speaking patients.
• Inadequate health literacy has a negative impact on patient management of both diabetes and hypertension.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through two grants totaling $879,684.