Health Literacy in Primary Care Practice

 


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Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension. Additionally, printed information should be written at or below a fifth- to sixth-grade reading level. Visual aids, graphs, or pictures can enhance patient understanding, as can more concrete presentation of numerical information.

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services.1 The wide range of skills that comprise health literacy and influence a patient's ability to navigate the health care system and make appropriate decisions about his or her health include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology.2

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Use universal health literacy precautions with all patients, regardless of their literacy or education levels.

C

10, 30, 31

Prioritize and limit information to three key points for each visit.

C

30

Use the teach-back method to assess patient comprehension of information.

C

10, 30, 36

Simplify forms and offer assistance with form completion.

C

10, 30


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Use universal health literacy precautions with all patients, regardless of their literacy or education levels.

C

10, 30, 31

Prioritize and limit information to three key points for each visit.

C

30

Use the teach-back method to assess patient comprehension of information.

C

10, 30, 36

Simplify forms and offer assistance with form completion.

C

10, 30


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

More than one-third of U.S. adults, an estimated 80 million persons, have limited health literacy,2,3 making it more difficult for them to read, understand, and apply health information (e.g., wording on medication bottles, food labels, appointment slips, discharge instructions, informed consent documents, medical forms, insurance applications, medical bills, and health education materials). Although U.S. adults on average read at an eighth-grade level, more than 75% of patient education materials are written at a high school or college reading level.4

Physicians often overlook health literacy in routine patient care, overestimating patients' health literacy skills and incorrectly assuming that health information and instructions have been understood.5,6 In addition, most patients fail to identify their own deficiencies in comprehension and overestimate their recall of important information.7

Numerous policy and advocacy organizations have recognized the negative effects of limited health literacy on patient safety and the quality of health care. As a result, health literacy has evolved from a poorly recognized “silent epidemic” to a major issue in health policy and reform.3,8

Epidemiology

The best population data on health literacy in the United States come from the 2003 National Assessment of Adult Literacy (NAAL).2  Commissioned by the U.S. Department of Education, the NAAL categorizes health literacy into four tiers reflecting the ability of patients to undertake increasingly complex tasks within the health

The Authors

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LAUREN HERSH, MD, is an instructor in the Department of Family and Community Medicine at Thomas Jefferson University in Philadelphia, Pa....

BROOKE SALZMAN, MD, is an associate professor in the Department of Family and Community Medicine at Thomas Jefferson University.

DANIELLE SNYDERMAN, MD, is an assistant professor in the Department of Family and Community Medicine at Thomas Jefferson University.

Author disclosure: No relevant financial affiliation.

Address correspondence to Lauren Hersh, MD, Thomas Jefferson University Hospital, 833 Chestnut St., Ste. 301, Philadelphia, PA 19107 (e-mail: lauren.hersh@jefferson.edu). Reprints are not available from the authors.

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