Healthcare Dilemma: Low Health Literacy Casts Long Patient Safety Shadow

Terri Tye

The Joint Commission

By Terri Tye

“Can you imagine what it’s like being sick, and you know that you have limited skills, okay, and you’re talking to an intelligent doctor. And these people are using words that you really don’t know because they are not speaking in layman’s terms, OK?”

These comments are from Mrs. Walker – a well composed, articulate woman who reads at the third-grade level – in the video “Health Literacy: Help Your Patients Understand,” produced by the American Medical Association Foundation.

Describing the dilemma of struggling to understand physicians when receiving treatment instructions, she continues: “So you come out of that examination room with this intelligent man or woman thinking, God I hope I don’t make a mistake with my medicine because I did not understand anything he or she said to me.”

Mrs. Walker is not alone. She is one among a large segment of the population who is suffering from low health literacy. “Health literacy” is defined 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.1 This issue is fast becoming a serious concern for the American healthcare system.

Literacy Linked to Health Literacy

The risk of miscommunication and unsafe care is not solely the potential fate of those who cannot read. Rather, it is a risk for a large segment of the American population, even those with basic and intermediate literacy skills. For instance, according to the most recent national literacy study on prose literacy skills, 29 percent have only basic while 14 percent have below basic skills.2 An additional 5 percent are non-literate in English.3 About half of the U.S. adult population has difficulty using text to accomplish everyday tasks.4 The ability of the average American to use numbers is even lower – 33 percent with basic and 22 percent with below basic quantitative skills.5

Most Americans, or 44 percent, fall into the “intermediate” level of prose literacy.6 That is, they can apply information from moderately dense text and make simple inferences. Yet, healthcare information – such as insurance forms, consent forms and medication instructions – is often very complex and seemingly impenetrable. Even those who are most proficient at using text and numbers may be compromised in the understanding of healthcare information when they are challenged by sickness and feelings of vulnerability. The Joint Commission’s accreditation standards underscore the fundamental right and need for patients to receive oral and written information about their care that is clear and understandable to them.

For this reason, the Joint Commission appointed a Roundtable panel comprising a broad range of experts and stakeholders accountable for addressing health literacy. Three broad recommendations resulted from the discussion, which offer a real opportunity to improve health literacy, reduce communications-related errors and better support the interests of both patients and providers. Below is a brief paragraph about each recommendation, lifted from a more in-depth research report available on the Joint Commission Web site called “What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety.”

I. Prioritize Effective Communications

If a patient does not understand the implications of his or her diagnosis and the importance of prevention and treatment plans, or cannot access healthcare services because of communications problems, an untoward event may occur.

A few of the recommended solutions include more awareness about low health literacy, patient-centered environments, clear communications and clinical staff training on health literacy.

II. Address Needs Across Continuum of Care

At all points across the continuum of care, low health literacy levels and ineffective communications can compromise patient safety. A few of the recommended solutions include education about when to seek care, insurance forms written at a low health literacy level, communications techniques, disease management and patient decision support aids.

III. Promote Physician-Patient Communications

Physicians today are compelled to squeeze more patients into their work day, thus creating the “15-minute office visit.” A few recommended solutions include more patient-centered educational materials and programs, health-related curricula in adult learning programs and pay-per-performance strategies.

Hundreds of studies have revealed that the skills required to comprehend healthcare-related communications far exceed the abilities of the average person. The amelioration of medical error and adverse events must begin with creating cultures of safety and quality.

Read the full report at www.jointcommission.org.

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