The ability to use printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential.
This definition implies that literacy goes beyond simply being able to sound out or recognize words and understand text, but to the use of information for completion of day-to-day activities.
More recently health professionals have begun to focus on issues related to health literacy.
Health literacy is defined by the American Medical Association and in Healthy People 2010 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."
Health literacy is an individual level construct composed of a combination of attributes that can be used to explain and predict whether or not a patient has the ability to access, understand and apply health information in a manner necessary to successfully function within the health care system.
Individuals with inadequate health literacy may not understand instructions, whether written or verbal, on prescription drug bottles, appointment slips, health education brochures or pamphlets, and informed consent forms. At times these patients may seem to be noncompliant or are nonadherent to recommended care regimens but may not truly understand recommended health care tasks.
Inadequate functional health literacy can impact management of diabetes and oral health and can lead to poor health outcomes and increased health care costs.
Ninety million people in the United States have difficulty understanding and using health information
Health Literacy: A Prescription to End Confusion,
..."a stronger predictor of a person's health than age, income, employment status, education level, and race"
In Health Literacy: A Prescription to End Confusion, the Institute of Medicine reports that ninety million people in the United States have difficulty understanding and using health information.
The American Medical Association states that inadequate health literacy is "a stronger predictor of a person's health than age, income, employment status, education level, and race"
Making inadequate health literacy an important aspect to address, and take into consideration in the delivery of patient care.
Health care providers are often unaware of patients' reading abilities
The patient encounter is most often oral/verbal communication, yet the majority of care instructions, including follow-up and medication information, are provided in print.
Numerous studies have shown that health materials, including patient education brochures, discharge instruction sheets, contraception instructions, and informed consent documents are often written at levels far exceeding patients' reading abilities.
As a result, patients commonly do not feel their physicians adequately explain illness or treatment plans in understandable terms (Mayeaux et al., 1996). Additionally, patients often times do not ask for clarification. Providers should not assume that patients correctly understand their diagnoses and treatment plans. For example, a 2002 study found that healthcare providers are often unaware of patients' reading abilities and assume understanding of health-related information based on superficial or descriptive characteristics of patients including race/ethnicity and dress.
However, all patients regardless of educational background may be at risk for inadequate health literacy.
The patient encounter is most often an oral or a verbal exchange of information, this information may be best understood by patients and used to determine care needs. The majority of printed care instructions including illness information, follow-up recommendations and medication instructions provided to patients may not be read or is only referred to following a problem or issue. Therefore, the patient-provider encounter and exchange during the typically short office visit is critical for addressing daily management tasks and follow-up care needs.
Non-verbal cues during the interaction between the provider and patient are essential to identifying areas where there is a need for additional information, explanation, or alternative care instructions.
The "teach-back" method is an effective technique for ensuring that patients understand care regimens and follow-up instructions. The technique asks patients to explain or demonstrate how they will apply the instructions they have been given. For example, you can say, "I want you to explain to me how you would explain to someone how you take your medications, this will help me make sure that I have explained everything." If the patient does not explain correctly, assume that you have not provided adequate teaching. Re-teach the information using alternate language and examples.
Ask Me 3
The Ask-Me-3 program is a more formal, but potentially effective approach to encouraging questions. Sponsored by the Partnership for Clear Health Communication, a large consortium of professional organizations that includes the American Medical Association Foundation, Ask-Me-3 encourages patients to ask, and physicians to answer, three basic questions during every medical encounter:
• What is my main problem?
• What do I need to do (about the problem)?
• Why is it important for me to do this?
Evidence shows that even long after Ask-Me-3 is implemented in a practice, many patients continue to ask the questions, and find them a useful framework for engaging in conversation with their clinician.
Engage in conversation to identify priorities and current care practices:
Finally, it is important to engage the patient in two-way communication regarding their diabetes care priorities. Identifying what is most important to the individual patient may allow for the tailoring of a care regimen and setting of diabetes management goals that are most appropriate and achievable.