Abstract
The design of the U.S. healthcare system along with increasing expectations of individuals create barriers to health care. One barrier is limited Health Literacy (HL). This essential healthcare ingredient is often disregarded (Murphy-Knoll, 2007). There is debate concerning the definition of HL (Sorensen, Van den Broucke, Fullam, Doyle, Pelikan, Slonska, & Brand, 2012). Still, there is consensus that HL is necessary for quality healthcare (Parker & Gazmararian, 2003) and that HL deficiencies must be addressed. Limited HL independently contributes to poorer health status, greater risk of hospitalizations, and increased likelihood of mortality (Hanchate, Ash, Gazmararian, Wolf, & Paasche-Orlow, 2008; Jeppesen, Coyle, & Miser, 2009). Much is known about HL. Still, few advancements have been made due to gaps between what we know about HL, and the application of that knowledge (Ishikiawa & Kiuchi, 2010). The purpose of this chapter is to provide a HL overview and recommend improvement strategies.
TopIntroduction To Health Literacy
The U.S. healthcare system is a fast evolving system with innovative advances and giant leaps in knowledge (Grande & Srinivas, 2001). Medical knowledge doubles every six to eight years with cutting-edge medical procedures introduced continuously. (Mantovani, Castelnuovo, Gaggioli, & Riva, 2003). These advances have led to phenomenal improvements and today contemporary medicine is commonplace. America has the most technologically rigorous medical system in the world (Chernichovsky & Leibowitz, 2010), and offers some of the best healthcare worldwide (McCarthy, 2003). Nevertheless, it is generally acknowledged that the U.S. healthcare system experiences poorer health outcomes than healthcare systems in other developed countries (Chernichovsky & Leibowitz, 2010). It is the world’s most expensive healthcare system (Bible & Lee, 2009) and it may not provide the care many Americans need (McCarthy, 2003). This lack of healthcare access eventually leads to health disparities (Chernichovsky & Leibowitz, 2010).
While the growth and evolution of the U.S. healthcare system have generated numerous advantages, there are also significant disadvantages. The growing complexity associated with using the healthcare system creates serious barriers to healthcare quality and access. One such barrier is limited or limited health literacy. The healthcare system is often very difficult to navigate. It has been described as overwhelming and complex (Passche-Orlow, Parker, Gazmararian, Neilsen-Bohlman, & Rudd, 2005); intricate, disjointed and specialized (Mika, Kelly, Price, Franquiz, & Villerreal, 2005); complicated and confusing (Paasche-Orlow & Wolf, 2007); and so fragmented and inefficient that it should be significantly overhauled (McCarthy, 2001, p. 782). In spite of all the medical innovations which pave the way for groundbreaking treatments and advanced technologies, a basic but essential healthcare ingredient – health literacy, is often overlooked in the U.S. healthcare environment (Murphy-Knoll, 2007). Approximately four decades ago a professor of health education, Dr. Scott K. Simonds, suggested that more emphasis be placed on health literacy when he recommended minimum standards for health literacy be established for all grade levels K through 12 (Simonds, 1974, p. 9). But policymakers, administrators, and researchers failed to act on the recommendation and it was nearly 20 years later that widespread attention was given to health literacy as an important healthcare component (Egbert & Nanna, 2009). 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” (IOM, 2004, p. 32). While this definition places emphasis on individual capability, it does not address the specific skills needed to successfully manage one’s health (Institute of Medicine (IOM), 2009). The extent to which an individual has health literacy is directly linked to his or her ability to utilize the healthcare system to positively impact their health status.
Key Terms in this Chapter
National Adult Literacy Survey: A comprehensive study of adult literacy first conducted in 1992 by the Educational Testing Services on behalf of the U.S. Department of Education. The study measured the English literacy skills of a random sample of individuals in the United States aged 16 years and older.
Communicative (Interactive) Literacy: “More advanced cognitive and literacy skills which, together with social skills, can be used to actively participate in everyday activities, to extract information and derive meaning from different forms of communications, and to apply new information to changing circumstances” ( Nutbeam, 2000 ).
Health Outcomes: “A change in the health status of an individual, group, or population which is attributable to a planned intervention or series of interventions, regardless of whether such an intervention was intended to change health status” (WHO, 1998, p. 10).
Health Literacy: “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (IOM, 2004, p. 32).
Limited Health Literacy: A literacy skill level that is below level three on the National Adult Literacy Survey. This skill level is lower than what is necessary to obtain, process, and understand basic health information and services to make appropriate health decisions.
Health Status: “A description and/or measurement of the health of an individual or population at a particular point in time against identifiable standards, usually by reference to health indicators” (WHO, 1998, p. 12).
Basic (Functional) Literacy: “Sufficient basic skills in reading and writing to be able to function effectively in everyday situations” ( Nutbeam, 2000 ).
Healthcare Provider: Any person or entity that provides healthcare services to individuals, including hospitals, health clinics, outpatient centers, physicians, physician assistants, nurses, social workers, health educators, pharmacists, technicians, etc.
Health Literacy Intervention: Policies, procedures, and processes designed to mitigate the effects of low health literacy on patient-provider communication.
General Literacy: “The ability to read, write, and speak in English, and to compute and solve problems at levels of proficiency necessary to function on the job and in society, achieve one’s goals, and develop ones knowledge and potential” ( National Institute for Literacy, 1991 , p. 6).
Critical Literacy: “ More advanced cognitive skills, which together with social skills, can be applied to critically analyze information, and to use this information to exert greater control over life events and situations” ( Nutbeam, 2000 ).