When you hear the term health literacy, what comes to mind? Many people view this solely as a measure of a patient’s comprehension level, but it involves so much more than that. Being able to read an educational pamphlet, for instance, is only one small aspect. The WHO defines health literacy as “the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions.”
Patients in today’s complex healthcare system are tasked with finding care, processing large amounts of information, making decisions about medical services, navigating insurance systems, and much more. Sometimes, extensive follow-up is needed… or a second opinion is warranted… or care by multiple providers needs to be coordinated. It’s a lot of responsibility. What may seem like a simple task can quickly become a confusing, daunting undertaking.
To make things more complicated, research shows that healthcare providers on the frontlines are often ill-equipped to support high-risk patients with low health literacy levels. Add implicit bias and structural racism to the mix, and we’ve got a much bigger problem.
Black and brown people have poorer experiences with healthcare than white people, and racial and ethnic minorities have the worst health outcomes across various measures. Many healthcare providers don’t take a personalized enough approach to education or involve patients in decision-making. As Vernā Myers so aptly put it, “Diversity is being invited to the party. Inclusion is being asked to dance.”
Unsurprisingly, low health literacy is associated with many adverse health outcomes. Studies show that traditional health education is less likely to resonate with patients who have low health literacy, and these patients are less proactive when it comes to preventing and managing disease. For these reasons, economically and/or socially disadvantaged populations also suffer disproportionate health disparities and worse health outcomes.
This is why all health educators need to focus on improving health literacy, and urgently. Because health literacy can be viewed as both a midstream social determinant of health, and a tool for potentially driving health equity. You might be surprised to learn that most Americans read at a 7th-8th grade level, but many patient education pieces are college-level.
The bottom line is — we have a long way to go to make health education more inclusive, but it’s entirely possible.
Many things can be done to empower patients to self-advocate and take an active role in their health management. We can:
- Increase access to health information via community outreach and technology
- Deliver education in a way that’s easy to understand, and
- Create materials that are sensitive to the needs of high-risk populations
Of course, this is not a complete solution because many social and economic factors drive health disparities. But improving health literacy among high-risk patients may help offset some drivers of health inequities - like inadequate schooling, language barriers, and lacking access to community health resources (to name just a few).
Now, you may think that the onus is on health institutions, doctors, and researchers to accommodate different health literacy levels. And it is… but not just them, because this is a huge undertaking! It requires a cross-sectoral approach, with many different stakeholders in healthcare playing a role. Enter pharmaceutical companies, healthcare marketers, community health workers, nurse navigators… anyone who creates or delivers health education can (and should) adopt and reinforce health literacy best practices.
Doing this involves more than simplifying text or using plain language; it also means:
- Reaching patients through the most effective channels
- Using symbols and infographics to make patient education more inclusive
- Crafting education that is culturally sensitive and empathetic to the needs of the population you’re targeting (e.g., creating materials in multiple languages)
- Using creative formats like animated videos or illustrated text to deliver education
- Encouraging healthcare providers to use “teach-back” communication techniques, to reinforce education and confirm the patient comprehends it
Getting my MPH and working at ENTRADA have given me opportunities to apply some of these methodologies. I’ve realized that more concerted efforts around health literacy are especially needed when developing educational programs for patients with chronic and rare diseases, as these patients often feel isolated and misunderstood. Further, comprehensible information about certain rare diseases is often harder to find.
Going forward, I’ll continue to educate myself on health literacy research and initiatives, lead with empathy, and explore new emerging health education strategies. Prioritizing health literacy will be more important than ever in this post-pandemic environment where many are struggling to access essential health services, and the only thing we can truly be certain of, is uncertainty.
To my friends and colleagues working in healthcare and public health, I hope you will join me.