Low health literacy is a significant barrier to quality care, especially among elderly patients, but increased use of simple and effective health literacy assessment tests by health care professionals can help improve communication and health outcomes, according to a presentation at the 36th Annual Congress of the Oncology Nursing Society. Furthermore, health care professionals routinely underestimate the prevalence of limited health literacy—the degree to which an individual can obtain, process, and understand health information needed to make health decisions—and overestimate patients’ ability to understand medical information.
A 2003 survey by the National Assessment of Adult Literacy showed that 36% of American adults overall have limited health literacy. Nearly 60% of those over age 65 meet only basic or below-basic health literacy levels.
Previous studies have shown that low health literacy adversely impacts cancer incidence, mortality, and quality of life. For example, missed or misunderstood cancer screening information can result in patients being diagnosed at a later, less treatable stage. Treatment decisions may not be fully comprehended and informed consent documents may be too complex, affecting medical decision making. Low health literacy has also been shown to increase hospitalization rates and ER visits, medication errors, and health care costs.
Several health literacy screening tools are readily available, including the Rapid Estimate of Adult Literacy in Medicine (REALM), the Test of Functional Health Literacy in Adults (TOFHLA), the Wide Range Achievement Test (WRAT), and the Newest Vital Signs assessment. The tests take health care professionals roughly three minutes to perform.
“Health literacy is particularly pertinent for cancer patients and the elderly, who may have hearing or vision problems that further complicate communication,” says Ellen C. Mullen, RN, ANP-BC, GNP-BC, nurse practitioner at the University of Texas MD Anderson Cancer Center and report presenter.
Once literacy is assessed, health care professionals should tailor their communications—oral and written—to match the patient’s level of understanding. For patients with low literacy, health care professionals can:
- Develop written materials below fifth grade reading levels;
- Keep content and format simple, with shorter words and sentences;
- Use larger, boldface or underlined fonts, increasing space between lines and black ink;
- Have a magnifying glass and good lighting available for older adults;
- Ensure patients have assistive devices, such as reading glasses and hearing aids; and
- Involve a significant other or caregiver.
Patients can also be referred to online resources for medical information and community programs that help improve health literacy levels.
Source: University of Texas MD Anderson Cancer Center