A crucial part of the success of health-care reform is consumers taking an active role in their health-care decisions.
Patients who know more about their medical conditions will have better health and will be able to access higher-quality care, according to the experts.
Health literacy, as defined by the Department of Health and Human Services in its HealthyPeople 2010, is "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."
Health Literacy Problem
HealthyPeople 2010 continues to explain that, “health literacy requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.”
This means patients understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms and the overall ability to navigate the system.
Much of the above may seem commonplace-but research proves differently.
The U.S. Department of Education reports only a staggering 12% of English-speaking adults in the U.S. have proficient health-literacy skills.
“Attention to health literacy is gaining momentum,” says Susan Pisano, spokesperson for America’s Health Insurance Plans.
As evidence of this, health experts have pulled together a diverse multi-stakeholder group which draws representation from national health organizations like the Department of Health and Human Services , The Centers for Disease Control, the Institute of Medicine and the American Medical Association along with experts from academia, industry and health plans and payers.
Though most common among low income, minority groups, non- English speaking individuals and the elderly, health illiteracy cuts across all social stratas.
The elderly can particularly run into trouble if they don’t understand their treatment plan.
“The average American over 65 typically takes six different medicines prescribed by at least eight different providers,” explains Dr. Ruth Parker, professor of medicine at Emory University Medical School. “As a patient, it becomes difficult to know what to do.”
What’s more, chronic conditions and wellness make health literacy an important component of self health management. People who are medically illiterate engage in less preventive care, use emergency rooms more, experience more frequent and longer hospital stays—situations that, according to Pisano, put as much as an additional $200 billion price tag on the cost of U.S. health care.
Health-care providers, along with payers, health plans and hospital systems, are taking action with system-based approaches that standardize the way the system works,” says Parker. “As health-care providers we have to ask ourselves ‘What is it that we ask patients to understand?’”
Shame plays a huge part in patients not speaking up.
That is why health literacy is so multi-tiered, says Kara Jacobson, a senior research associate at Emory’s Rollins School of Public Health. “Friendliness matters from the health worker at the front desk on up in making patients feel comfortable. That alone strips the burden of shame.”
This is also why the American Medical Association is taking a look at health-literacy reform through an organizational lens. An AMA tool kit provides both assessment and study tools to help organizations establish environments in which patients feel at ease.
“We have some good interventions like the ‘teach back’ and the ‘chunk and check,’” says Dr. Matthew Wynia, a Chicago-based infectious disease specialist at the University of Chicago Hospital.
The “teach back” requires doctors to ask their patients to talk back with an understanding about what the doctor has said about care. “Chunk and check” necessitates doctors provide serial chunks of information to patients during a visit.
Some hospitals also have patient navigator programs, which assign workers to help people move around the medical center, manage medical appointments or serve as interpreters.
Parker and Jacobson are also engaged to make prescription bottle labels more user friendly. Your script may say to take your medication two times a day, but does that mean morning and night, every 12 hours, or something else?
Last year, she and Parker researched swine flu medications to look for confusing label direction. The children’s medicine label directed a ¾ teaspoon and provided an administration syringe measured in grams.
The pair is also involved with creating associative icons that make label directions easier to understand. Many adult consumers may not realize, for example, that compliance for taking acetaminophen, the active ingredient in many over-the-counter medications, should not exceed a four-gram daily dosage. Because all drugs have similar active ingredients, researchers are working with the creation of icons and other graphics to provide user-friendly warnings.
Parker added that patients are also invaluable stakeholders in improving medical literacy. The secret to creating understandable content and comfortable interactions is asking patients what they think.