Health Literacy: A Review
Health Literacy: A Review
Illiteracy has become an increasingly important problem, especially as it relates to health care. A national survey found that almost half of the adult population has deficiencies in reading or computation skills. Literacy is defined as the basic ability to read and speak English, whereas functional health literacy is the ability to read, understand, and act on health information. Up to 48% of English-speaking patients do not have adequate functional health literacy. The consequences of inadequate health literacy include poorer health status, lack of knowledge about medical care and medical conditions, decreased comprehension of medical information, lack of understanding and use of preventive services, poorer self-reported health, poorer compliance rates, increased hospitalizations, and increased health care costs. The medical community must acknowledge this issue and develop strategies to ensure that patients receive assistance in overcoming the barriers that limit their ability to function adequately in the health care environment.
Illiteracy in the United States has become an increasingly important problem, especially as it relates to health care. Although children in this country have the opportunity for a free education, a large proportion of adults have considerable limitations with functional literacy. Deficiencies in basic reading, computation, and comprehension skills significantly affect the lives of many people in the United States. Illiteracy affects the quality of medical care, as patients are not able to perform necessary functions in the health care environment such as reading an appointment slip or following the directions on a prescription label. The most accurate assessment of this problem is reflected in the National Adult Literacy Survey (NALS) published in 1993. The National Center for Education Statistics surveyed more than 26,000 randomly selected Americans and provided a detailed picture of their literacy skills to represent the country as a whole. The intent of the survey was not to measure literacy by reading level or last grade completed, but to assess how literacy skills affect the ability to function in everyday life situations. It included assessments of prose literacy (the ability to understand prose), document literacy (the ability to interpret documents), and quantitative literacy (the ability to perform mathematical tasks).
The NALS found that 40-44 million Americans, or approximately one-quarter of the population, were functionally illiterate. Another 50 million U.S. citizens had marginal literacy skills. This indicates that nearly half of the adult population in our country has inadequacies in reading or computation skills. Although 5% of this group have learning disabilities and 15% were born outside this country, most are Caucasian, native-born Americans. The survey was a random selection of Americans and was weighted to represent all ethnic groups equally. African-Americans were more likely to score lower, but, overall, Caucasians made up a large percentage of those with inadequate literacy. The mean reading level of adults in the United States was 8th grade, although Medicaid enrollees had a mean reading level of 5th grade. The problem of inadequate literacy was particularly prevalent in the elderly, with 44% of those aged 65 years or older scoring in the lowest reading skill level in the NALS. Other subgroups with a high percentage of persons scoring in the lowest literacy levels included those who were living in poverty, had fewer years of education, had health problems, or were imprisoned. As health care professionals, we must work to increase the awareness of health illiteracy and begin to identify and implement solutions to improve the health care needs of these patients.
Abstract and Introduction
Abstract
Illiteracy has become an increasingly important problem, especially as it relates to health care. A national survey found that almost half of the adult population has deficiencies in reading or computation skills. Literacy is defined as the basic ability to read and speak English, whereas functional health literacy is the ability to read, understand, and act on health information. Up to 48% of English-speaking patients do not have adequate functional health literacy. The consequences of inadequate health literacy include poorer health status, lack of knowledge about medical care and medical conditions, decreased comprehension of medical information, lack of understanding and use of preventive services, poorer self-reported health, poorer compliance rates, increased hospitalizations, and increased health care costs. The medical community must acknowledge this issue and develop strategies to ensure that patients receive assistance in overcoming the barriers that limit their ability to function adequately in the health care environment.
Introduction
Illiteracy in the United States has become an increasingly important problem, especially as it relates to health care. Although children in this country have the opportunity for a free education, a large proportion of adults have considerable limitations with functional literacy. Deficiencies in basic reading, computation, and comprehension skills significantly affect the lives of many people in the United States. Illiteracy affects the quality of medical care, as patients are not able to perform necessary functions in the health care environment such as reading an appointment slip or following the directions on a prescription label. The most accurate assessment of this problem is reflected in the National Adult Literacy Survey (NALS) published in 1993. The National Center for Education Statistics surveyed more than 26,000 randomly selected Americans and provided a detailed picture of their literacy skills to represent the country as a whole. The intent of the survey was not to measure literacy by reading level or last grade completed, but to assess how literacy skills affect the ability to function in everyday life situations. It included assessments of prose literacy (the ability to understand prose), document literacy (the ability to interpret documents), and quantitative literacy (the ability to perform mathematical tasks).
The NALS found that 40-44 million Americans, or approximately one-quarter of the population, were functionally illiterate. Another 50 million U.S. citizens had marginal literacy skills. This indicates that nearly half of the adult population in our country has inadequacies in reading or computation skills. Although 5% of this group have learning disabilities and 15% were born outside this country, most are Caucasian, native-born Americans. The survey was a random selection of Americans and was weighted to represent all ethnic groups equally. African-Americans were more likely to score lower, but, overall, Caucasians made up a large percentage of those with inadequate literacy. The mean reading level of adults in the United States was 8th grade, although Medicaid enrollees had a mean reading level of 5th grade. The problem of inadequate literacy was particularly prevalent in the elderly, with 44% of those aged 65 years or older scoring in the lowest reading skill level in the NALS. Other subgroups with a high percentage of persons scoring in the lowest literacy levels included those who were living in poverty, had fewer years of education, had health problems, or were imprisoned. As health care professionals, we must work to increase the awareness of health illiteracy and begin to identify and implement solutions to improve the health care needs of these patients.
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