How to Improve Patient Health Literacy

According to the 2003 National Assessment of adult literacy conducted by the U.S. Department of Education, only 12% of adults had proficient levels of health literacy. Most adults (53%) had intermediate health literacy, and older adults aged 65 and older had lower average health literacy than younger groups.

 Low health literacy levels are linked to longer hospital stays, medical errors, inadequate management of chronic diseases, and poor health outcomes. Nonetheless, health literacy practices across healthcare systems to address low literacy still faces many barriers.

The major barrier to addressing health literacy – among healthcare organizations and medical practices – is not recognizing there is a problem. Other considerable barriers are limited time available for physicians to spend with patients, socioeconomic factors, patients with low English proficiency, and patients with cognitive decline, hearing or visual impairment, or mental health problems. Healthcare organizations must focus on providing real patient-centered care, thus addressing the health literacy needs of all patients served.

There are diverse ways in which healthcare organizations can improve patient health literacy and drive positive health outcomes. Some strategies that healthcare organizations can use to boost health literacy among their patients are: 

• Create easy-to-understand materials.
• Assess language assistance needs and language preferences.
• Communicate clearly
• Learn about patients’ health beliefs, customs, and culture.
• Teach patients to be discerning consumers of internet content. 
• Seek patients’ input and feedback on organizational health literacy policies.

The Agency for Healthcare Research and Quality (AHRQ) offers numerous resources and toolkits for healthcare professionals to implement health literacy policies and practices in their organizations. Various other resources on the internet also help healthcare organizations to become more health literate, but the AHRQ website is a great starting point. 

Any success cases of health literate healthcare organizations? Numerous. 

Here is a great example: 

During a roundtable event on health literacy, Dr. McCandeless shared the case of The Shared Care Free Clinic in Jackson County, Missouri, which implemented health literacy policies and had great results. At Shared Care Free Clinic, patients are typically uninsured adults whose incomes are below 200 percent of the federal poverty level and who have complex multiple chronic illnesses. Patients also have low health literacy levels. 

What were some of the strategies implemented by Shared Free Clinic?

• Complex patient regimens and treatment plans were simplified and segmented into smaller pieces that patients could process a little bit at a time. 
• Encouraged physicians to simplify their vocabulary.
• The clinic implemented the strategy to select the most important pieces of information to communicate to the patient. They shortened all patient educational material at the clinic to just one page. 
• Providers started to use the teach-back method. In this method, following a discussion about their treatment plan with the doctor, the patient explains to the provider in their own words the treatment plan, how to accomplish it, and agrees to follow the plan.
• Another successful tool equipped to energize patients to engage in their care and with their providers is the patient preparation sheet. This sheet provides something to think about they are waiting to be seen by the provider. Some examples of questions were as follows: “Are you having a hard time taking your medication?” or “What is it that you need in patient education?”. 

What were some of the results obtained by Shared Free Clinic through their new health literate approach?

• Improvements in communications skills in its post-care surveys.
• Health literacy became an integral part of the clinic’s hypertension and diabetic messaging.
• Exceptional adherence rates to very complex treatment regimens.
• Much higher rate of screening than for patients with health insurance.
• Extraordinary adherence rates to medications.
• 80% of the patients completed the patient preparation form before the doctor entered the exam room. 

Organizational health literacy can have a powerful impact on an individual’s health. Therefore, health literacy can make a difference in how patients understand diagnosis, treatment plans, or recommended lifestyle changes to live healthy lives. But, before healthcare organizations head into becoming health literate organizations, they should cautiously delineate their goals, assess their needs, and plan their resources.