Written materials are a crucial element of patient health education, the process by which patients are taught about their healthcare situations and needs.

Fisher E. Low literacy levels in adults: implications for patients education. J Contin Educ Nurs. 1999;30(2):56–61.

 

However, discrepancies have been reported between the reading level of these materials and that of many patients. This is problematic, as patients who can’t read instructions and information regarding their care are unable to fully participate in it and make informed decisions.

 

Prevalence of low health literacy

Health literacy is defined as an individual's ability to read, understand, and act upon health-related information.

Smith LS. When your patient can’t read or write. Nursing. 2015;45(2):67–69.

 

The prevalence of low health literacy is surprisingly high, with 77 million people in the US lacking health literacy, putting them at increased risk for problems in a healthcare setting.

Low health literacy has been linked to nonadherence to medical treatments, increased risk of hospitalizations and rehospitalizations, malpractice suits, poor clinical outcomes, increased medication errors, and heightened healthcare costs.

 

How to assess health literacy

Due to the stigma associated with low health literacy levels, patients may not always disclose that they don’t understand instructions. The level of education listed on an individual's admission form may not be a good indicator of their level of health literacy, as years of schooling aren’t necessarily indicative of an individual’s current literacy skills.

Healthcare providers can evaluate patients by using formal health literacy assessment tools. One such tool is the Rapid Estimate of Adult Literacy in Medicine Short Form, also known as the REALM-SF.

Health literacy measurement tools (Revised). Agency for Healthcare Research and Quality. November 2019.

It’s available from the Agency for Healthcare Research and Quality.

 

In addition to formal tools for assessing health literacy, healthcare providers should be on the watch for these red flags indicating low health literacy:

• Incomplete or unfinished healthcare forms

• Problems with understanding medication and treatment instructions

• Failure to show up for follow-up appointments

• Reluctance to read health information in your presence

• Inability to explain or share what they’ve read or learned

• Irregular serum drug levels

• Inappropriate behavior such as abruptly leaving the office or hospital when asked to fill out health forms

 

Alternative strategies

The ultimate goal of patient health education is to make sure patients are aware of their healthcare needs and can participate in the dialogue about their care to ensure the best clinical outcomes. If you find your patient has low health literacy, be empathetic and respectful, and tailor their care by recognizing that everyone has unique learning needs.

Use short words and sentences with all communication, whether verbal or written, and avoid using any medical jargon.

Use lay terminology whenever possible. For example, instead of saying “hypertension” and “myocardial infarction,” say “high blood pressure” and “heart attack,” respectively.

You can also use illustrations, audio or videotaped information, charts, graphs, and diagrams to supplement verbal and written information.

 

The power of pictures

In a report published in BMJ Open Quality, researchers found that discharge prescriptions that utilized pictures and symbols, instead of words, increased comprehension among illiterate patients in Lahore, Pakistan.

Clayton M, Syed F, Rashid A, et al. Improving illiterate patients’ understanding and adherence to discharge medications.BMJ Qual Improv Report. 2012;1(1):u496.w167.

 

Baseline measurements revealed that nearly half of the hospital’s patients were illiterate, with only 5% to 12% able to comprehend handwritten discharge instructions.

However, that number increased to 23% to 35% of patients able to comprehend discharge instructions after healthcare providers started utilizing pictures and symbols instead of handwritten notes.