Among the many challenges brought on by the pandemic are the feelings of isolation and helplessness faced by many Americans because of social distancing recommendations by public health officials. These sentiments can affect people’s confidence and ability to take care of their health. In times like this, health care leaders and innovators have an opportunity to tackle these challenges by strengthening health literacy efforts at both the individual and organizational/community levels.
CURA Strategies sat down with transformational leader Dr. Paula Allen-Meares, Executive Director of the Office of Health Literacy at the University of Illinois Chicago (UIC), to share the importance of personal and organizational health literacy.
CURA: How would you describe health literacy to someone unfamiliar with the term?
Dr. Paula Allen-Meares: Health literacy is a contextual and multidimensional phenomenon that is not only an individual ability; it involves individuals, their families, their communities, and the healthcare system at large (Orkan et al., 2019). Health literacy can be broken down into two major types:
- Personal health literacy: This deals with the individual—it is the degree to which the individual is able to find, understand, and use information and services to make well-informed decisions and actions about his/her own health or the health of others. Personal health literacy requires a variety of skills including verbal communication, visual literacy, numerical literacy, and computer literacy (UHIP, 2021)
- Organizational health literacy: Organizations have a responsibility to address health literacy and equitably to enable individuals to exercise personal health literacy. Thus, organizational health literacy is the degree to which an organization enables the individual to find, understand, and use information and services to make well-informed health-related decisions (Centers for Disease Control and Prevention, 2021).
CURA: Healthy People 2030—the U.S. Department of Health and Human Services (HHS)’s 10-year plan to address our nation’s most critical public health priorities and challenges—outlines health literacy as a significant barrier to health care access and quality. Why is health literacy such a barrier and what role does health literacy play in improving our health care system and patient outcomes?
Dr. Allen-Meares: Navigating the healthcare system is a skill encompassed by health literacy (Allen-Meares et al., 2020). When patients are faced with navigating the nation’s complicated healthcare system, those with low health literacy are at a major disadvantage. Adults with limited English skills, for example, receive far less health care than those proficient in English (Frellick, 2021). Decreased utilization of healthcare services, particularly preventative services, is associated with poorer health outcomes. In other words, there are human costs of limited health literacy. Individuals with limited health literacy are more likely to have chronic conditions. At the same time, they are less able to manage these conditions effectively—limited health literacy may create a barrier that makes communicating with healthcare providers, following health recommendations, taking recommended medication as directed, and following up with appointments and referrals difficult.
Since limited health literacy results in an increase in preventable hospital visits and admissions, limited health literacy is expensive (The Office of Disease Prevention & Health Promotion, 2021). It is estimated that improving health literacy could prevent nearly 1 million hospital visits and save over $25 billion a year (UnitedHealth Group, 2020). Therefore, improved health literacy not only plays a role in improving patient outcomes and quality of life but also in reducing ineffective healthcare spending.
CURA: What are some of the key strategies you recommend for improving health literacy in our country?
Dr. Allen-Meares: Healthcare organizations and healthcare providers can implement several key strategies to improve health literacy in our country.
- The healthcare provider should consider how the patient’s language, language fluency, and culture impact the achievement of cross-cultural understanding during encounters. If the patient is faced with a barrier to understanding such as limited English proficiency, she should be provided with an interpreter.
- Providers should utilize brief health literacy assessment tools to understand the patient’s level of health literacy, adapt communication, and ultimately achieve better outcomes. Regardless of a patient’s perceived or assessed level of health literacy, providers should adopt a “universal precautions” approach in which they use clear and simple language and limit the amount of information shared with the patient during each encounter (Agency for Healthcare Research and Quality, 2020).
- Throughout and after the encounter, providers should assess patient recall and comprehension. The teach-back method, for instance, involves the provider asking the patient to repeat the information she has heard, as opposed to simply asking the patient, “Do you understand?”.
For healthcare organizations:
- Organizations should create and distribute written materials that use clear and concise language at a sixth-grade or lower reading level and incorporate visual aids such as pictures, illustrations, and tables.
- In order to structure health content in an appropriate manner for patients, organizations should also use formative research and gather information from those with limited health literacy (Allen-Meares et al., 2020).
CURA: Are there any resources you’d recommend for someone to either look to improve their own personal health literacy or for organizations looking to enhance health literacy within their communities?
- The Centers for Disease Control and Prevention (CDC) offers several valuable resources to improve health literacy within their communities, including health literacy training for healthcare providers, health literacy tools for program implementation, and health literacy evaluation tools. The CDC’s resources can be accessed with the following link: Office of Health Literacy at the University of Illinois Chicago.
- The Office of Disease Prevention and Health Promotion (ODPHP) provides many health literacy resources, such as health literacy measurements and tools, cultural competence, and health communication. The ODPHP’s resources can be assessed at the following link: https://health.gov/our-work/national-health-initiatives/health-literacy/resources.
- The Agency for Healthcare Research and Quality (AHRQ) provides health literacy improvement tools, health literacy education and training, and health literacy publications. The AHRQ’s resources can be accessed at the following link: https://www.ahrq.gov/health-literacy/index.html.
- Duke University Medical Center provides a few useful health literacy resources, such as a program to promote communication among patients and providers, questions to ask providers, a program to help patients learn medical words, and more. Duke’s patient resources can be accessed at the following link: https://guides.mclibrary.duke.edu/healthliteracy/patients#s-lg-box-3107855.
About Dr. Paula Allen-Meares
- Chancellor Emerita
- John Corbally Presidential Professor Emerita
- Professor of Medicine
- Executive Director, Office of Health Literacy
- University of Illinois Chicago
- Dean and Professor Emerita/Norma Radin Collegiate Professor, University of Michigan
Dr. Allen-Meares is an elected member of the National Academy of Medicine (NAM) and the Royal Society of Medicine who has authored or co-authored over 170 publications in scholarly journals and publications. In addition to the many other hats she wears, Dr. Allen-Meares and currently leads the Office of Health Literacy at UIC as Executive Director to advance the scientific base of health literacy and to help people understand the importance of health literacy.
- Agency for Healthcare Research and Quality. (2021). Health literacy. AHRQ. Retrieved October 23, 2021, from https://www.ahrq.gov/health-literacy/index.html.
- Agency for Healthcare Research and Quality. (2020). AHRQ Health Literacy Universal Precautions Toolkit. https://www.ahrq.gov/health-literacy/improve/precautions/index.html
- Allen-Meares, P., Lowry, B., Estrella, M. L., & Mansuri, S. (2020). Health Literacy Barriers in the health care system: Barriers and opportunities for the profession. Health & Social Work, 45(1), 62–64. https://doi.org/10.1093/hsw/hlz034
- Centers for Disease Control and Prevention. (2021, October 1). Health literacy: Accurate, accessible and actionable health information for all. Centers for Disease Control and Prevention. Retrieved October 23, 2021, from https://www.cdc.gov/healthliteracy/index.html.
- Centers for Disease Control and Prevention. (2021, May 19). What is Health Literacy?. https://www.cdc.gov/healthliteracy/learn/index.html
- Duke University. (2018, August 24). Health literacy: For patients. Duke University Medical Center Library & Archives. Retrieved October 23, 2021, from https://guides.mclibrary.duke.edu/healthliteracy/patients#s-lg-box-3107855.
- Frellick, M. (2021, July 9). Limited English proficiency linked with less health care in U.S. Family Practice News. https://www.mdedge.com/familymedicine/article/242760/business-medicine/limited-english-proficiency-linked-less-health-care
- The Office of Disease Prevention and Health Promotion. (2021, August 24). Health Literacy Resources. Office of Disease Prevention and Health Promotion. Retrieved October 23, 2021, from https://health.gov/our-work/national-health-initiatives/health-literacy/resources.
- Orkan, O., Ullrich, B., Levin-Zamir, D., Pinheiro, P., & Sorensen, K. (2019). International Handbook of Health Literacy. Policy Press.
- UHIP. (2021). Health Literacy Programs and Training Sessions. https://uhipnj.org/health-literacy-services/
- UnitedHealth Group. (2020). Improving Health Literacy Could Prevent Nearly 1 Million Hospital Visits and Save Over $25 Billion a Year. https://www.unitedhealthgroup.com/content/dam/UHG/PDF/About/Health-Literacy-Brief.pdf