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Health Literacy & Why Plain Language

What is Health Literacy?

Health literacy is much broader than just the ability to read. The U.S. Department of Health and Human Services defined 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" (Healthy People 2010). It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.

Health literacy varies by context and setting and is not necessarily related to years of education or general reading ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment. With the move towards a more "consumer-centric" health care system as part of an overall effort to improve the quality of health care and to reduce health care costs, individuals need to take an even more active role in health care related decisions. To accomplish this people need strong health information skills.

-Adapted from: http://nnlm.gov/outreach/consumer/hlthlit.html

Many factors contribute to health literacy being a challenge for most American adults, including:

• the need to access and use health-related information across multiple media, topics, and environments;
• the unfamiliarity of the vocabulary and concepts in health and medicine;
• the complexity of our healthcare system;
• the increasing demands on consumers to prevent and manage health conditions;
• anxiety related to the illness or condition and the need to navigate all of the above.

Why is Health Literacy important?

For the 93 million adults across the country with limited literacy skills, health literacy is an even larger challenge. Low health literacy negatively impacts health outcomes. Adults with low health literacy:

• Are often less likely to comply with prescribed treatment and self-care regimens
• less knowledge and less likelihood of getting specific preventive tests and exams, even with equal access to care;
• Make more medication or treatment errors
• have poorer self-reported health and poorer health outcomes;
• Are at a higher risk for hospitalization than people with adequate literacy skills and remain in hospital nearly 2 days longer
• Lack the skills needed to negotiate the health care system

-Adapted in part from: http://www.pfizerhealthliteracy.com/public-health-professionals/stats-at-a-glance.html, retrieved 6/22/10

Elders- Interestingly, several research studies have documented that elders (adults 65 and older) are at particular risk of low health literacy. Literacy abilities decline progressively with age, posing a large and growing healthcare risk as our entire population ages.

Does Plain Language Help?

While research doesn’t provide any easy “solutions” to the challenge of health literacy, national reports do state the need for clear language (IOM report) and “well-conceived interventions” (AHRQ). Plain language, as defined by well-established criteria, IS clear language and certainly is part of a well-conceived intervention. While not a magic bullet, it can help all adults better understand health information and make wise health-related choices.

-From: http://www.healthliteracyinstitute.net/abouthl.html (retrieved 11/12/10).

Researchers have studied brochures and booklets that use plain language and are written at reading grades below high school levels for a wide range of public health issues, such as immunizations (Evers, 2001), hepatitis (Wilson, 2003), breast self-exams (Colman et al, 2003), and Diabetes care (Echeverry, Dike, Washington & Davidson, 2003). In most instances, materials more appropriately matched with the reading skills of the intended audience have been associated with healthful outcomes such as decreased emergency department visits (Herman & Mayer, 2004) and decreased anxiety (Coyne et al, 2003).

-Review of Adult Learning and Literacy, A Project of the National Center for the Study of Adult Learning and Literacy, chapt 6 (p.194).