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Report Finds Americans' Health Literacy Lacking

Odds are, you’ve attempted to explain a prehospital intervention to a patient who, for some reason, could not understand what you were trying to communicate. Maybe it was a language barrier; maybe they just didn’t fathom the terms you were using. This was probably frustrating for both of you, and it may have negatively impacted the care you were able to give them.

Health literacy is a big problem in the United States. An estimated 90 million Americans sometimes have trouble comprehending and acting upon health information. In light of this, the Institute of Medicine’s Committee on Health Literacy has compiled a comprehensive report on the subject. Health Literacy: A Prescription to End Confusion looks at the scope of health illiteracy in this country, weighs its consequences and poses some solutions that may help all Americans gain better access to the benefits of the healthcare system.

The Committee defines health literacy as “the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” The concept involves a number of factors, both individual and social. These include people’s education, culture and language; the assessment and communication skills of those in the healthcare system; and the ability of the media, the marketplace and government to provide healthcare information in a manner appropriate for their intended audience.

While current health literacy indicators—largely reading-based—are insufficient for determining the full scope of the problem, this much seems certain: It’s not just about being smart.

“Many people who deal effectively with other aspects of their lives may find health information difficult to obtain, understand or use,” wrote the authors, led by Committee Chair David A. Kindig, MD, PhD, of the Wisconsin Public Health and Health Policy Institute at the University of Wisconsin. “While farmers may be able to use fertilizers effectively, they may not understand the safety information provided with the fertilizer. A chef may create excellent dishes, but may not know how to create a healthy diet. Indeed, health literacy can be a hidden problem.”

The effects of poor health literacy are hard to quantify, but it is thought there is some relationship between literacy deficiencies and poor health outcomes. Citing more than two dozen studies, the authors posit that “Individuals with inadequate health literacy…report less knowledge about their medical conditions and treatment, worse health status, less understanding and use of preventive services, and a higher rate of hospitalization than those with marginal or adequate health literacy.”

Broadly, the Committee identified three major areas in which interventions could improve health literacy: across culture/society; within the health system; and within the educational system.

For those in EMS, the initial steps can be simple.

“Think about setting up training sessions to help staff know how to ask questions that get the best answers,” stated one literacy advocate in the report. “Make sure compassion is part of the training. Use plain language, not medicalese.”

Copies of the report are available from the National Academies Press,

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