Medical Professional Publications

Health Literacy and Patient Education

(From the April 2013 Issue of MedStat)

In 2004, the Institute of Medicine published Health Literacy: A Prescription to End Confusion. The report highlighted the fact that “nearly half of all American adults — 90 million people — have difficulty understanding and using health information, and that there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy.” The economic impact is estimated to be billions of dollars in avoidable health care costs. In fact, the National Patient Safety Foundation reports that “the annual health care costs for individuals with low literacy skills are 4 times higher than those with higher literacy skills.”

The U.S. Department of Health and Human Services defines health literacy 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.” Patients and/or parents who do not understand the basic health care instructions are at risk of being non-compliant with a health care provider’s treatment, medication instructions or preventive medicine instructions. The Institute of Medicine report further points out that health literacy entails more than the ability to read. In fact, health literacy is a complex group of reading, listening, analytical and decision-making skills. For example, the patient must be able to understand the instructions for taking medications, appointments, scheduled tests and patient education materials. The inability to do so can result in potentially harmful or even life-threatening mistakes.

The United States’ increasingly multicultural population presents new barriers and challenges to providing the patient and family with needed education that is essential to promote and achieve optimal health outcomes. The National Patient Safety Foundation also reports that, according to the Center for Health Care Strategies, a disproportionate number of minorities and immigrants are estimated to have literacy problems that affect “approximately 50 percent of Hispanics, 40 percent of Blacks and 33 percent of Asians.”

The following risk management information is from the National Patient Safety Foundation and from CNA, a medical malpractice insurance carrier.

  • Have some basic understanding of the cultural beliefs, practices and languages of your patient populations. Doing so helps you better serve your patients, helps protect them from poor health outcomes and can help protect you from medical malpractice claims.
  • Spoken and written communication must be both culturally appropriate and simply presented.
  • Assess each patient individually and do not make generalizations.
  • Choose words that reflect respect for the individual and for his/her culture.
  • Offer teaching materials in the primary language of patients with limited English proficiency.
  • Provide competent medical translators or readers; unskilled interpreters are more likely to make a potentially harmful translation error. Federal regulations regarding interpreters note that a patient’s family and friends may be less accurate and objective when acting as an interpreter. Using a child as an interpreter is discouraged.
  • Use visual models to clarify complex ideas.
  • Use plain language instead of technical or medical jargon; for example, say this medication “keeps bones strong” instead of “it will prevent osteoporosis.”
  • Ask open-ended questions rather than questions that can be answered with a simple yes or no.
  • Use teaching tools and other materials written at the fifth-grade level to ensure that your patient understands. For example, use the word “give” rather than “administer,” and the words “birth control” instead of “contraception.” This is important because data shows that one out of five American adults reads at the 5th grade level or below, the average American reads at the 8th to 9th grade level, and that most health care information is written above the 10th grade level.
  • Organize patient education information carefully and present it so that the most important points are first, stand out and are repeated.
  • Use printed information, videos, audios, models and pictures to support oral education.
  • Instead of asking, “Do you understand?,” ask the patient or parent to repeat back to you in his/her own words what you have just discussed and decided about care and treatment.
  • Visit the National Patient Safety Foundation’s website at for the free tool entitled “Ask Me 3” that is provided by the Partnership for Clear Health Communication. “Ask Me 3” is a patient education program that targets improved communication between the patient and the physician by teaching all patients three simple, direct questions to always ask their health care provider in order to improve health outcomes: 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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