A New Era for Health Literacy?
Meet Susan. Susan is a 66-year-old woman who lives alone. She is referred to a clinic following a 2-week stay in the hospital. When asked by clinic staff why she was admitted, Susan says, “I had a bad cold.” Her hospital records, however, show an admission for pneumonia complicated by congestive heart failure and diabetes. Although Susan’s hospital physicians said they communicated these diagnoses, she was discharged from the hospital without fully understanding her condition. She skipped her next follow-up appointment because doctors “talked over her head.”
Unfortunately, Susan’s situation is not uncommon. At least 88% of adults living in the US have health literacy levels that deter them from navigating the healthcare system and promoting their well-being. People with low health literacy use emergency services more often, access preventive services less frequently, and may not understand how to choose or get the most out of their health insurance plans. And while there is little doubt that prioritizing health literacy can produce significant cost savings—possibly up to $236 billion annually—health-related organizations have largely overlooked the impact of health literacy on care outcomes and costs, until now.
What is health literacy anyway?
“Personal Health literacy is 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 Healthy People 2030, a U.S. Department of Health and Human Services initiative that establishes national objectives for health improvement. “Organizational Health Literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”
This new binary definition moves the needle from the individual’s ability to understand health information to their ability use it—that is, to seamlessly navigate care and insurance channels, talk to healthcare providers, and advocate for their own health. It also recognizes the responsibility of healthcare organizations to communicate information in an accessible and equitable way. Under this scenario, our patient Susan would not have left the hospital without demonstrating clear understanding of the steps for getting better and staying better.
Wake-up in progress
Research shows that patients immediately forget 40-80% of what they’re told by healthcare practitioners during office visits. When it comes to hospitalized patients, a large percentage do not understand their plan of care, and providers frequently overestimate patients’ comprehension of their discharge instructions. Moreover, low health literacy affects seniors’ ability to select an appropriate health plan: one in five may end up in a health plan that fails to cover their needs. People with low health system literacy also have a higher-than-average need for customer service, costing payers an estimated $4.8 billion annually.
But stakeholders are waking up to the fact that the specialized terminology of healthcare and health insurance is unrelatable to a large swath of consumers, and that addressing health literacy through low-cost reforms can improve health-related behaviors. For example, a UnitedHealth Group report examining health literacy levels in counties across the U.S. found that Medicare beneficiaries with higher health literacy received 31% more flu shots, experienced 26% fewer unnecessary hospitalizations, had 18% fewer emergency department visits, and 9% fewer hospital readmissions. Moreover, spending per beneficiary was, on average, $700 less in counties with the highest literacy levels. These numbers suggest the wide-ranging benefit of adopting practices that actively improve health literacy.
Simple, low-cost interventions
Here are five well-established strategies for communicating with people facing health literacy challenges:
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Limit jargon and avoid using acronyms: Explain potentially confusing information, such as diagnoses, care options, or health-plan specifics in clear, simple language. Keep in mind that using so-called plain language is not “dumbing down” or “talking down” to people but rather focusing on what they need to know and do.
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Understand your audience. Assess people’s learning competency and needs by asking questions using the words “what” or “how” rather than those that can be answered with a simple “yes” or “no.” For instance, try asking “What questions do you have?” instead of “Do you have any questions?”
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Organize the information: To better engage patients, break up complex information into understandable chunks, starting off with the most significant “need to know” points. Try to stay with one topic at a time and avoid details that would be “nice to know.” Using sentences that are 15 words or less will make the information easier to process and remember.
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Confirm Understanding. Use the “teach-back” method to ensure understanding by asking a person to restate key information in their own words. A good prompt might be: “We’ve gone over a lot of information, and I want to make sure I explained things clearly. So, tell me, what do you think are the three most important things to know about taking your medications?” When understanding is not accurate or complete, explain things using a different approach and ask the person to teach-back again.
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Assess and address non-medical challenges. Health literacy is not only about addressing clinical conditions but also encompasses social determinants of health. Communicate opportunities for support in areas such as food or job insecurity using the same principles applied to discussing medical and insurance issues.
While some in healthcare argue that today’s time-crunched environment leaves no bandwidth for systematizing even these modest interventions, almost all agree that if people don’t understand what providers and customer service advocates are saying, we will never achieve the patient engagement needed to improve outcomes. People like Susan will instead turn to obtaining health information from their friends, Google, and YouTube videos.
So, as government policymakers amplify their commitment to health literacy as a cornerstone to equity, we in the healthcare ecosystem are being called to follow suit. This means giving every consumer the time, attention, and resources they deserve to make fully informed health decisions—with no shaming or blaming. If we fail this time, we’ll have only ourselves to blame.
