The Imperative to Improve Health Literacy

Nov 19, 2014, 7:59 PM

Joy P. Deupree, PhD, MSN, APRN-BC, is an assistant professor at the University of Alabama (UAB) School of Nursing and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow. She is engaged in community participatory research studies on health literacy. For 12 years, Deupree has taught a campus-wide elective on health literacy and has been a guest lecturer on the topic at the UAB schools of medicine, dentistry and public health. She founded the Alliance of International Nurses for Improved Health Literacy and established a nursing special interest group for the Health Literacy Annual Research Conference.

Health literacy is extremely important to building a culture of health. Basic understanding of health care information is essential if people are to live healthy lives, but an alarming number of American adults report poor understanding of health care instructions. 

This year marks the 10-year anniversary of the Institute of Medicine (IOM) report, Health Literacy: A Prescription to End Confusion. While progress has been made, the work has really just begun. We can no longer blame the patient for poor health literacy, and we should keep in mind that limited health literacy affects us as all and contributes to increased health care costs. 

The IOM report defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” These skills involve not only reading ability but also numeracy. Failure to develop the necessary skills to manage health care can cost millions of dollars as well as add to human suffering and even cause death.

Research has documented that most health care providers have a poor understanding of how serious the limited health literacy problem is; few know how to identify patients at risk or know how to help a patient with limited health literacy.

Health care providers have said to me, “I understand health literacy; it is patient education.” Health literacy does involve patient education, but it is much more complex than a simple item, task or definition. It involves systems, providers at every level, ancillary staff, the insurance industry, policymakers, patients and families.

As we begin to build a culture of health utilizing best practices for health literacy, we should consider the many recommendations made by academia, industry, government, foundations and associations, and representatives of patient and consumer interest groups to address this serious and costly issue. These recommendations include primary preventative care that includes a strong health literacy component to reduce health care costs, improve the effectiveness of treatment, and provide patients with care of the highest possible quality.

Let’s consider how to use evidenced-based practices for improving health literacy:

1.      We must engage the public in advocating for patient-provider communication that delivers high-quality health care through interventions that engage the community and the entire health care system in each community;

2.      We should prioritize strategies that eliminate disparities in health literacy; every community has different resources. We should work with health care systems and communities to identify strengths and weaknesses in order to develop strategies that show promise to improve limited health literacy.

3.      We should facilitate expertise and guidance to develop policies, strategic goals, and procedures to promote health literacy. Accreditation organizations and those from the insurance industry that do not have a health literacy expert at the decision-making level should add a place for them; board certifying agencies should strengthen objectives and requirements to make sure health care professionals are knowledgeable of best practices for patient communication and are creating appropriate messages that use plain language to present easy-to-understand health care instructions; and licensing boards for all health care professionals should establish minimum standards so all entry level health care providers as well as those already working can identify and refer limited health-literate patients, so they get the care they need.

4.      We should facilitate interprofessional collaboration to advance health literacy. Physicians and nurses are at the forefront and can make the greatest difference, but some states have few—if any—initiatives to improve health literacy. We should look at states that have provided an excellent example of how to establish a strong and meaningful statewide health literacy organization and replicate that in every state.

5.      Finally, we should recognize and reward excellence in advancing health literacy. For health care systems that implement strong health literacy interventions and develop strong initiatives, the cost-saving measures will be a huge reward. Patients will have fewer hospital readmissions, and patients and communities will be healthier.

We must not blame patients but instead promote solutions that incorporate the experience of patients in the development of a microsystems approach for delivery of care. We must seek out opportunities for health care providers to link health literacy to quality measures and integrate health literacy performance measurements into every aspect of the patient experience, so patient-centered care with patient engagement for improved health literacy is at the center of the discussion for building a culture of health.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.