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  • Health Literacy

    By Marilyn McDonald DHSc, APRN, AGNP
    AGNP Program Lead
    Kaplan University School of Nursing

    The Patient Protection and Affordable Care Act (2010) defines health literacy as "The degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions."  The national public health initiative—Healthy People 2020—first identified limited health literacy in the year 2000 (healthypeople.gov). 

    Health illiteracy became a public health issue because when a person has limited or low health literacy it is difficult for them to read prescriptions, medication labels, patient education material, medical forms, appointment slips, and discharge instructions. This also applies to the use of electronic technology which has been increasingly used to convey health information.

    Limited health literacy is an important public health issue as it can affect patient safety and health outcomes. Adults with limited health literacy are less likely to effectively manage chronic illnesses and more likely to be hospitalized. Therefore, health costs are higher (https://health.gov/communication/literacy/quickguide/quickguide.pdf).

    The number of Americans with limited health literacy is staggering. According to the U.S. Deptartment of Health and Human Services (2010) nearly 9 out of 10 adults have difficulty using everyday health information that is routinely available. The National Assessment of Literacy (NAAL) was conducted in 2003 by the U.S. Department of Education. Although the survey was conducted in 2003 it is the best population data to date that studied literacy and health literacy.  

    According to the NAAL, only 12%of adults have proficient health literacy. The survey found that 36% of adults have limited health literacy. The survey indicated that Hispanics, Blacks, American Indians, and Alaskan Natives are more health illiterate than Caucasians. Additional factors included low education, poverty, age, and those that did not speak English before starting school (Hersh, Salzman and Snyderman, 2015).

    The NAAL found that older adults were the highest risk group for limited health literacy. Fifty nine percent of adults over age 65 who responded to the NAAL reported limited health literacy (U.S. Department of Health and Human Services, 2010). This could be because older adults may already be compromised with sensory and/or cognitive deficits. Older adults may lack access or be unable to use electronic technology. They are also more likely to have a chronic illness. Additionally, many older adults lack social support.

    Role of the Provider

    Part of the problem contributing to low health literacy may be the patient care provider. A lack of understanding of risks for low health literacy leads to poor communication between the provider and the patient. The numbers of health illiterate adults is enormous and therefore all patients should be considered at risk. 

    The American Medical Association and The Agency for Healthcare Quality and Research endorse the use of universal precautions to minimize the risk that a patient will not understand the health information they are given (Hersh, Salzman, and Snyderman. 2015).

    Patient education materials can always be improved to be user friendly and age appropriate. The following strategies can be used:

    • Utilize health literacy screening tools
    • Listen carefully to the patient
    • Speak slowly and clearly and always allow time for questions
    • Simplify medical jargon and use teaching formats that patients can understand
    • Know when to involve an interpreter
    • The older adult may need large print
    • The caregiver of an older adult should always be included

    Older adults may need referral to their community Aging and Disability Resource Center for additional assistance

    • A follow up with the patients is essential to ensure that the patient understands the plan of care

    The benefits of health literacy include patient safety, less hospitalizations, a greater ability to care for oneself, and a greater cost savings to the health care system. When patients, providers, and communities work together to improve health literacy a greater quality of life will result.

    For Resources to Learn More about Health Literacy go to:


    Marilyn McDonald DHSc, APRN, AGNP, is a program lead at the School of Nursing. The views expressed in this article are solely those of the author and do not represent the view of Kaplan University.

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