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MEDICAL :
HEALTH :
INFORMATION LITERACY :
HEALTH: INFORMATION LITERACY:
Health Literacy
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Health Literacy
National Network of Libraries of Medicine
National Library of Medicine
8600 Rockville Pike, Bldg. 38, Room B1-E03
Bethesda, Maryland 20894
http://nnlm.gov/outreach/consumer/hlthlit.html
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Topics on this page:
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Definition
Skills Needed for Health Literacy
Background
Research Findings on Impact of Literacy
Economic Impact of Low Health Literacy
Role of the Consumer Health Librarian
Health Literacy Organizations and Programs
Bibliographies, Webliographies, and Web Resources
Health Literacy Listservs
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Definition
In the report Healthy People 2010
(http://www.healthypeople.gov/Document/pdf/uih/2010uih.pdf)
the U.S. Department of Health and Human Services included improved
consumer health literacy as Objective 11-2, and identified health literacy
as an important component of health communication, medical product safety,
and oral health. Health literacy is defined in Health People 2010 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".
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Health literacy includes the ability to understand instructions on
prescription drug bottles, appointment slips, medical education brochures,
doctor's directions and consent forms, and the ability to negotiate
complex health care systems. Health literacy is not simply the ability to
read. It requires a complex group of reading, listening, analytical, and
decision-making skills, and the ability to apply these skills to health
situations.
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Health literacy varies by context and setting and is not necessarily
related to years of education or general reading ability. A person who
functions adequately at home or work may have marginal or inadequate
literacy in a health care environment. With the move towards a more
"consumer-centric" health care system as part of an overall effort to
improve the quality of health care and to reduce health care costs,
individuals need to take an even more active role in health care related
decisions. To accomplish this people need strong health information
skills.
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Skills Needed for Health Literacy
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Patients are often faced with complex information and treatment decisions.
Some of the specific tasks patients are required to carry out may include:
evaluating information for credibility and quality,
analyzing relative risks and benefits,
calculating dosages,
interpreting test results, or
locating health information.
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In order to accomplish these tasks, individuals may need to be:
visually literate (able to understand graphs or other visual information),
computer literate (able to operate a computer),
information literate (able to obtain and apply relevant information), and
numerically or computationally literate (able to calculate or reason
numerically).
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Oral language skills are important as well. Patients need to articulate
their health concerns and describe their symptoms accurately. They need to
ask pertinent questions, and they need to understand spoken medical advice
or treatment directions. In an age of shared responsibility between
physician and patient for health care, patients need strong
decision-making skills. With the development of the Internet as a source
of health information, health literacy may also include the ability to
search the Internet and evaluate websites.
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Background
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According to the American Medical Association, poor health literacy is "a
stronger predictor of a person's health than age, income, employment
status, education level, and race" (Report on the Council of Scientific
Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific
Affairs, American Medical Association, JAMA, Feb 10, 1999). In Health
Literacy: A Prescription to End Confusion, the Institute of Medicine
reports that ninety million people in the United States, nearly half the
population, have difficulty understanding and using health information. As
a result, patients often take medicines on erratic schedules, miss
follow-up appointments, and do not understand instructions like "take on
an empty stomach".
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Vulnerable populations include:
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Elderly (age 65+) - Two thirds of U.S. adults age 60 and over have
inadequate or marginal literacy skills, and 81% of patients age 60 and
older at a public hospital could not read or understand basic materials
such as prescription labels (Williams, MV. JAMA, December 6, 1995).
Minority populations
Immigrant populations
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Low income - Approximately half of Medicare/Medicaid recipients read below
the fifth-grade level
http://www.medicarerights.org/maincontentstatsdemographics.html
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People with chronic mental and/or physical health conditions
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Reasons for limited literacy skills include:
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Lack of educational opportunity - people with a high school education or
lower
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Learning disabilities
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Cognitive declines in older adults
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Use it or lose it - Reading abilities are typically three to five grade
levels below the last year of school completed. Therefore, people with a
high school diploma, typically read at a seventh or eighth grade reading
level.
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The relationship between literacy and health is complex. Literacy impacts
health knowledge, health status, and access to health services. Health
status is influenced by several related socioeconomic factors. Literacy
impacts income level, occupation, education, housing, and access to
medical care. The poor and illiterate are more likely to work under
hazardous conditions or be exposed to environmental toxins.
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The results of the 1992 Adult Literacy Survey (National Center for
Education Statistics, US Department of Education) indicate that adults
with low literacy were more likely than those with higher literacy levels
to be poor and to have health conditions which limit their activities.
There are both direct and indirect consequences of low health literacy.
The direct effects include non-compliance or medication errors. The
indirect effects are harder to measure, but may include insurance issues,
accessibility to health care, and poor health behavior choices. "Groups
with the highest prevalence of chronic disease and the greatest need for
health care had the least ability to read and comprehend information
needed to function as patients", according to the Report on the Council of
Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on
Scientific Affairs, American Medical Association (JAMA, Feb 10, 1999).
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Research Findings on Impact of Literacy
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According to the Agency for Health Care Research and Quality Report,
Literacy and Health Outcomes (January 2004), low health literacy is linked
to higher rates of hospitalization and higher use of expensive emergency
services. This evidence-based literature review highlights numerous
studies that provide a detailed analysis of the correlation between low
health literacy and poor health. Below are just a few of the conclusions
from studies on health literacy and outcomes.
Cancer Treatment (Merriman, Betty, CA: A Cancer Journal for Physicians,
May/June 2002)
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Low literacy adversely impacts cancer incidence, mortality, and quality of
life. For example:
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1.Cancer screening information may be ineffective; as a result, patients
may be diagnosed at a later stage.
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2.Treatment options may not be fully understood; therefore, some patients
may not receive treatments that best meet their needs.
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3.Informed consent documents may be too complex for many patients and
consequently, patients may make suboptimal decisions about accepting or
rejecting interventions.
Diabetes (Schillinger, Dean, JAMA, July 24/31, 2002)
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Among primary care patients with Type 2 diabetes, inadequate health
literacy is independently associated with worse glycemic control and
higher rates of retinopathy. Inadequate health literacy may contribute to
the disproportionate burden of diabetes related problems among
disadvantaged populations.
Asthma (Williams, MV, Chest, October 1998)
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Inadequate literacy was common and strongly correlated with poorer
knowledge of asthma and improper metered-dose inhaler (MDI) use. More than
half of patients reading at a sixth-grade level or less report they go to
the Emergency Department when they have an attack compared with less than
a third of literate patients. Less than one third of patients with the
poorest reading skills knew they should see a physician when their asthma
was not symptomatic as compared with 90% of literate patients.
Hypertension and Diabetes (Williams MV, Archives of Internal Medicine,
January 26, 1998)
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Almost half (48%) of the patients with hypertension or diabetes in a study
had inadequate functional health literacy, and these patients had
significantly less knowledge of their disease, important lifestyle
modifications, and essential self-management skills, despite having
attended formal education classes
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Economic Impact of Low Health Literacy
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In addition to the effects of low health literacy on the individual
patient, there are economic consequences of low health literacy to
society. The National Academy on an Aging Society estimated that
additional health care costs due to low health literacy were about $73
billion in 1998 dollars
Health Literacy Fact Sheet
http://www.agingsociety.org/agingsociety/publications/fact/fact_low.html
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After adjusting for health status, education level, socioeconomic status,
and other demographics factors, people with low functional literacy have
less ability to care for chronic conditions and use more health care
services. The information below is from the Center on an Aging Society at
Georgetown University
http://hpi.georgetown.edu/agingsociety/pubhtml/healthlit.html
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Among adults who stayed overnight in a hospital in 1994, those with low
health literacy averaged 6% more hospital visits, and stayed in the
hospital nearly two days longer than adults with higher health literacy
skills.
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When self-reported health status is taken into account, patients with low
health literacy skills had fewer doctor visits but used substantially more
hospital resources.
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The estimated additional health care expenditures due to low health
literacy skills are about $73 billion in 1998 health care dollars. This
includes an estimated $30 billion for the population that is functionally
illiterate plus $43 billion for the population that is marginally
literate.
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This amount is about what Medicare is expected to pay to finance physician
services, dental services, home health care, prescription drugs, and
nursing home care combined.
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Medicare pays 39 percent of the expenditures. Medicaid pays more than $10
billion dollars, or 14 percent of the additional health care expenditures.
Most of the additional expenditure is financed through FICA taxes on
workers.
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Role of the Consumer Health Librarian
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Many consumer health initiatives are geared towards technological access
to health information or rewriting existing health materials at a simpler
language level. Both of these approaches are important, but limited.
Easy-to-read materials and access to technology are only pieces of a
process that must be placed in a larger community context.
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Consumer health librarians can actively develop partnerships with:
literacy groups (adult basic education, English as a Second Language,
etc.)
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community-based organizations
public and private schools (K-12)
public libraries
senior-citizen facilities (adult day care, 55+ housing complexes,
assisted-living facilities, nursing homes, etc.)
health care associations
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This may take the form of providing space for meetings, providing health
literacy materials, or actively developing health literacy programs.
Consumer health librarians can promote awareness of health literacy among
health professionals by creating clearinghouses of health literacy
information, sponsoring health literacy seminars, and encouraging
multi-organizational collaborations.
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Possible initiatives to consider include:
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Developing partnerships with K-12 school librarians, math teachers, health
teachers, science teachers, and school nurses to introduce health related
tasks into the curriculum
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Work with Adult Basic Education and English as a Second Language
initiatives to include health related information into the program
Partner with community-based organizations to develop outreach programs to
senior-citizen facilities to discuss health information topics
Health information classes at the public library to teach health related
topics
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Work with consumer advocate organizations on outreach programs to
vulnerable populations
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Consumer health librarians also need to participate in and lobby for
research on health literacy topics. The Council of Scientific Affairs, Ad
Hoc Committee on Health Literacy for the Council on Scientific Affairs,
American Medical Association (JAMA Feb. 10, 1999)) identified the need for
research on:
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1.literacy screening
2.methods of health education
3.medical outcomes and economic costs and
4.understanding the casual pathway of how literacy influences health
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Consumer health librarians can also support the direct needs of health
information consumers by providing materials that are multi-lingual,
culturally appropriate and easy to read, and by developing methods and
materials to teach consumers how to evaluate health information resources,
especially those found on the Internet.
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Health Literacy Organizations and Programs
Health Literacy. American Medical Association Foundation.
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http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/
our-programs/public-health/health-literacy-program.shtml
515 North State Street
Chicago, Illinois 60610
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Ask Me 3
http://www.npsf.org/askme3/
Sponsored by the Partnership for Clear Health Communication at the
National Patient Safety Foundation. "The National Patient Safety
Foundation's mission is to improve the safety of the health care system,
of which health literacy is a critical component. Understanding that
communication breakdowns are the leading source of medical errors, NPSF
will be integrating PCHC's flagship health literacy program, Ask Me 3,
into its program offerings. Ask Me 3 promotes three simple but essential
questions that patients should ask their providers in every health care
interaction: 1)What is my main problem?; 2) What do I need to do?; 3) Why
is it important for me to do this?
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National Literacy and Health Program. Canadian Public Health Association.
http://www.nlhp.cpha.ca/
Promotes awareness among health professionals of the links between
literacy and health.
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Health Literacy Studies
http://www.hsph.harvard.edu/healthliteracy/index.html
Harvard School of Public Health
Department of Society, Human Development and Health
677 Huntington Avenue, 7th Floor
Boston, MA 02115 USA
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National Center for the Study of Adult Learning and Literacy
Harvard University Graduate School of Education
Nichols House
7 Appian Way
Cambridge, MA 02138 USA
Phone: 617-432-3914
Fax: 617-432-3123
Email: [log in to unmask]
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Health Literacy Center, University of New England
http://www.une.edu/hlit/
Area Health Education Center Program
11 Hills Beach Road
Biddeford, ME 04005
Phone: 207-283-0171
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Health Literacy Consulting
http://www.healthliteracy.com/
Helen Osborne, M.Ed., OTR/L
31 Highland Street, Suite 201
Natick, MA 01760
Phone: 508-653-1199
Fax: 508-650-9492
Email: [log in to unmask]
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Health Literacy Month
http://www.healthliteracy.com/hlmonth/
Helen Osborne, M.Ed., OTR/L
31 Highland Street, Suite 201
Natick, MA 01760
Phone: 508-653-1199
Fax: 508-650-9492
Email: [log in to unmask]
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Literacy and Health Project
http://www.opha.on.ca/resources/i-n.html#literacy
Ontario Public Health Association and Frontier College
Phone: 416-367-3313.
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Medical Library Association
http://www.mlanet.org/resources/healthlit/
65 East Wacker Place, Suite 1900
Chicago, IL 60601-7246
Tel., 312.419.9094
Fax, 312.419.8950
[log in to unmask]
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A national organization of health science librarians. The Health
Information Toolkit includes information for Health and Information
Professions, and information for Consumers.
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Movement for Canadian Literacy (MCL)
http://www.literacy.ca/about/about.htm
A national non-profit organization representing literacy coalitions,
organizations, and individuals
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National Institute for Literacy
http://www.nifl.gov/
1775 I Street N.W., Suite 730
Washington DC 20006-2401
Phone: 202-233-2025
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Office of Minority Health
http://www.omhrc.gov/
PO Box 37337
Washington DC, 20013-773
Phone: 800-444-6472
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Pfizer Clear Health Communication Initiative
http://www.pfizerhealthliteracy.com/
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University of Virginia School of Medicine Health Literacy Curriculum
http://www.healthsystem.virginia.edu/internet/som-hlc/
PO Box 800325
Charlottesville, VA 22908
434-924-2629
Phone: 434-924-2629
Fax: 434-982-2597
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World Education, Health and Literacy Initiative
http://www.worlded.org/
44 Farnsworth Street
Boston, MA 02111-1211
Phone: 617-482-9485
Fax: 617-482-0617
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Bibliographies, Webliographies, and Web Resources
Understanding Health Literacy and its Barriers. National Library of
Medicine.
http://www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html
Current Bibliographies in Medicine 2004-1
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MEDLINE/PubMed Search and Health Literacy Information Resources.
National Library of Medicine.
http://www.nlm.nih.gov/services/health_literacy.html
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Proceedings of the Surgeon General's Workshop on Improving Health Literacy
September 7, 2006, National Institutes of Health, Bethesda, MD
http://www.surgeongeneral.gov/topics/healthliteracy/toc.htm
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Annotated Bibliographies: Health, Communication and Literacy
http://www.centreforliteracy.qc.ca/pubs.htm#biblios
The Centre for Literacy of Quebec
3040 Sherbrooke Street West, Room 4B. 1-6,
Montreal, QC H3Z 1A4, Canada
Phone: 514-931-8731 Fax: 514-931-5181
Email: [log in to unmask]
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Health and Literacy Compendium
http://www.worlded.org/us/health/docs/comp/index.html
Contains over 80 citations to print and web materials that cover the
links between health status and literacy status; how to assess and develop
easy-to-read health education materials; how to teach health with literacy
in mind, and how to teach literacy using health content; background
information on literacy and "participatory" education methodologies;
curricula and materials on a variety of health topics for adults with
limited literacy skills; bibliographies and databases of easy-to-read or
multi-lingual health information and brochures; bibliographies and
databases of materials about the connections between health and literacy.
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Health Literacy. Michigan Adult Learning & Technology Center.
http://www.malt.cmich.edu/healthlit.htm
Sections: Research about the literacy problem and designing easy-to-read
materials; the health literacy problem and the solution; legal writing in
plain English/legal implications of plain English; focus groups and field
testing; impact of marginal literacy on health and healthcare;
communications planning; sources of easy-to read patient education
materials; sources for clip art.
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Health Communication. Partners in Information Access for the Public Health
Workforce.
http://phpartners.org/hp/health_comm.html
Special PubMed queries on Healthy People 2010 topics
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Health Literacy Listservs
The Health Literacy Discussion List
http://lincs.ed.gov/mailman/listinfo/Healthliteracy
Complete the form on the Literacy Information and Communication System
(LINCS) website.
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Health Literacy Consulting
http://www.healthliteracy.com/newsletter.asp
Select "What's New" list - a free monthly message about the latest
articles and tips, and/or "Countdown to Health Literacy Month".
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Sincerely,
David Dillard
Temple University
(215) 204 - 4584
[log in to unmask]
http://daviddillard.businesscard2.com
Net-Gold
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General Internet & Print Resources
http://guides.temple.edu/general-internet
COUNTRIES
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EMPLOYMENT
http://guides.temple.edu/EMPLOYMENT
TOURISM
http://guides.temple.edu/tourism
DISABILITIES
http://guides.temple.edu/DISABILITIES
INDOOR GARDENING
http://tech.groups.yahoo.com/group/IndoorGardeningUrban/
Educator-Gold
http://groups.yahoo.com/group/Educator-Gold/
K12ADMINLIFE
http://groups.yahoo.com/group/K12AdminLIFE/
The Russell Conwell Learning Center Research Guide:
THE COLLEGE LEARNING CENTER
http://tinyurl.com/yae7w79
Nina Dillard's Photographs on Net-Gold
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and also http://gallery.me.com/neemers1
http://www.flickr.com/photos/neemers/
Twitter: davidpdillard
Bushell, R. & Sheldon, P. (eds),
Wellness and Tourism: Mind, Body, Spirit,
Place, New York: Cognizant Communication Books.
Wellness Tourism: Bibliographic and Webliographic Essay
David P. Dillard
http://tinyurl.com/p63whl
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INDOOR GARDENING
Improve Your Chances for Indoor Gardening Success
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HEALTH DIET FITNESS RECREATION SPORTS TOURISM
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http://groups.google.com/group/healthrecsport
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