The US Center for Disease Control and Prevention defines health literacy as "the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others."
According to the US Department of Health and Human Services, only 12% of US adults have proficient health literacy. This shows that, across all levels of education, 88% of Americans have less-than-proficient health literacy levels.
Figure 1 breaks down the percentage of US adults at each health literacy level, indicating that 35% have basic or below basic abilities to find, understand, and use health information in various forms. Some research estimates low health literacy at 50%.
Yet despite research finding associations between low health literacy and poorer health and greater healthcare utilization and cost, high health literacy leads to better health and wellness.
For Medicare beneficiaries, higher levels demonstrate better health outcomes, including:
- 31% more flu shots
- 26% fewer avoidable hospitalizations
- 9% fewer hospital readmissions
- 18% fewer emergency department visits
- 13% lower cost per beneficiary
We'll demonstrate that low health literacy is a far more pervasive and impactful issue than providers may realize. Providing support to improve understanding is critical to achieving all healthcare goals.
How pervasive is low health literacy?
"Too often, there exists a chasm of knowledge between what professionals know and what consumers and patients understand."
Howard K. Koh, MD, MPH, former United States Assistant Secretary for Health,
US Department of Health and Human Services,
National Action Plan to Improve Health Literacy, 2010
Navigating healthcare in the US requires a high degree of specialized and ongoing development of health literacy.
Healthcare providers expect patients to provide accurate health histories and symptom descriptions, as well as comprehend complex verbal and written instructions replete with technical jargon and terms.
Low health literacy challenges prevent providers from delivering effective care when their patients can't understand their condition, treatment options, and care plan instructions.
During a recent webinar hosted by ThoroughCare, the real-world scale of the issue came to light when an audience of primary and specialty care practices, ACOs, health systems, and care management service providers answered important poll questions shared in Figures 2 and 3.
Figure 2: Results to first poll question from ThoroughCare's health literacy webinar.
Figure 3: Results to second poll question from ThoroughCare's health literacy webinar.
Webinar participants reported that 85% of their patient encounters almost always or frequently involved limited health literacy. This finding is much higher than the national average.
Who experiences low health literacy?
It's critical to note that most adults struggle with health literacy at some point in their lives. Even with the benefit of more education and medicine, healthcare is complex, and new evidence and technologies continually change and evolve.
This is a fundamental understanding for providers because if even the most educated can be challenged, the disparities are more significant and severe for people with less education and health-related knowledge.
Figure 4: "America’s Health Literacy: Why We Need Accessible Health Information." Source.
As supported by Figure 4, research indicates that certain patient groups are more likely to have limited health literacy, including:
- Adults over the age of 65 years
- Racial and ethnic groups other than White
- Recent refugees and immigrants
- People with less than a high school degree or GED
- People with incomes at or below the poverty level
- Non-native speakers of English
Low health literacy keeps patients from preventing health issues, managing current health problems, and providing adequate support for their families.
Higher health literacy is fundamental to healthcare achieving its aims
Foundational to successful medical care and clinical outcomes is healthcare's responsibility to help patients turn complex information into clear, healthy action.
Improving health literacy requires understanding the cycle of patient-provider translation and mutual understanding
Figure 5 illustrates the process patients go through every time they engage with a clinician—from receiving new information to taking action. It's a complex chain, moving from receiving data, understanding that data, deciding that the information indicates a change in behavior for them, and taking decisive action.
Figure 5: Four stages of turning information into healthy action.
From a different perspective, patients engaging with providers is likened to two people interacting where one is bilingual and the other may only speak a little of the second language. A person fluent in both languages—the provider—must take extra steps to be understood.
As shown in Figure 6, patients and providers go through this cycle of interpretation and understanding during any interaction.
Figure 6: Cycle of patient-provider interpretation and mutual understanding.
Assessing and understanding a patient's level of health literacy ensures that providers can interpret the patient's input and provide adequate translation when offering the patient new information and recommendations.
What can physicians and their care teams do to improve patient health literacy?
It's essential to ensure that patients have the right level of health literacy to understand and act on the information providers share.
Assessing patient literacy levels and literacy needs
Tools like the Health Literacy Questionnaire (HLQ) can help identify patients’ a patient's health literacy strengths and gaps, as well as highlight how the provider needs to improve their skills to achieve mutual understanding.
The HLQ tool uses a Likert scale across nine areas to detect differences between the provider's perspective about a patient's health literacy level and the patient's perspective. Those nine areas include:
- Feeling understood and supported by healthcare providers
- Having sufficient information to manage my health
- Actively managing my health
- Social support for health
- Appraisal of health information
- Ability to actively engage with healthcare providers
- Navigating the healthcare system
- Ability to find good health information
- Understanding health information well enough to know what to do
Then, using the same health literacy levels as in Figure 1, Figure 7 indicates examples of the literacy level needed to engage with various types of health information and activities.
As physicians, care managers, and other providers on the care team assess a patient's literacy capacity, they can examine the care plan and its health activities, determine what level of literacy is needed, and decide how to help the patient expand their understanding.
ThoroughCare offers tools and evidence-based education to improve health literacy
There are three ways that ThoroughCare helps care teams improve health literacy.
Assess - First, we provide questions to guide an assessment of a patient's health literacy. For example, in our Chronic Care Management care plan, we ask, "Do you have a good understanding of your health conditions, including when to seek additional help from a healthcare provider?"
ThoroughCare also offers a Health Risk Assessment and enables care managers or providers to make note of observed health literacy challenges by adding a condition called "Education or Literacy Issues."
Analyze - Second, we offer analytics based on health literacy answers, which can be visualized across populations through the Analytics module. It displays a pie chart with patients' most recent responses that users can drill into to identify a list of patients with their demographic details who have expressed a need for health literacy support.
Educate - Third, ThoroughCare integrates evidence-based health education from Healthwise that is accessible, approachable, and actionable. With Healthwise, multimedia articles and videos help educate patients about their conditions and provide a knowledge base for care managers working directly with patients. They can even track engagement with the material to conduct personalized follow-ups.
Covering more than 8,500 topics, Healthwise is accurate, inclusive, and engaging:
- Their clinical review board comprises 150 health professionals and medical specialists from over 50 specialties.
- Meets diverse literacy levels and learning types with education written at or below a 6th-grade reading level, including text, visuals, and 800+ videos.
- All Healthwise education is available in English and Spanish, with commonly used content in 15 additional languages.
- Healthwise touts an average 81% completion rate and the ability to follow individual engagement with analytics.
- Through NCQA accreditation, Healthwise offers validated education that meets health literacy benchmarks.
Key questions answered
What is health literacy?
The US Center for Disease Control and Prevention (CDC) defines health literacy as "the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others."
How many US adults have low health literacy?
According to the US Department of Health and Human Services, 35% of US adults have basic or below basic abilities to find, understand, and use health information in various forms. Their research indicates that only 12% of US adults have proficient health literacy. This shows that, across all levels of education, 88% of Americans have less-than-proficient health literacy levels.
According to survey participants attending a ThoroughCare webinar, 85% of patient encounters almost always or frequently involved limited health literacy.
What impact does low health literacy have on patient and healthcare outcomes?
Low health literacy keeps patients from preventing health issues, managing current health problems, and providing adequate support for their families. Low health literacy has been associated with poor health outcomes and contributes to health disparities.
Research has shown that differences in health literacy level are consistently associated with increased hospitalizations, greater emergency care use, and lower use of preventive vaccinations and screenings.