Thu, Feb 01, 2007 - Page 9 News List

The importance of health literacy

Millions of people in the US are unable to adequately understand basic health information, and the consequences can be grave

By Jane Brody

How often have you left a doctor's office wondering just what you were told about your health, or what exactly you were supposed to be doing to relieve or prevent a problem? If you are a typical patient, you remember less than half of what your doctor tries to explain.

Whether you left school at 16 or have a doctorate; whether your annual income is in four figures or six; whether you are black, white, Hispanic, Asian or American Indian, chances are there have been many medical encounters that left you with less than optimal understanding about how you can improve or protect your health.

National studies have found that "health literacy" is remarkably low, with more than 90 million Americans unable to adequately understand basic health information. The studies show that this obstacle "affects people of all ages, races, income and education levels," Dr Richard Carmona, the US surgeon general, wrote in the August issue of the Journal of General Internal Medicine, which was devoted to health literacy.

The fallout is anything but trivial. Researchers have found that poor health literacy, which is especially prevalent among the elderly, results in poor adherence to prescription instructions, infrequent use of preventive medical services, increased hospitalizations and visits to the emergency room and worse control of chronic diseases.

The consequences are poorer health and greater medical costs. All because doctors fail to speak to patients in plain English (or Spanish or Chinese or any other language) and fail to make sure that patients understand what they are told and what they are supposed to do and why.

Twice as likely to die

In a study published in the internal medicine journal, conducted among 2,512 elderly men and women living on their own in Memphis and Pittsburgh, those with limited health literacy were nearly twice as likely to die in a five-year period as were those with adequate health literacy.

That held true even when age, race, socioeconomic factors, current health conditions, health care access and health-related behaviors were taken into account.

Another study in the journal among 175 adult asthma patients treated by Cornell University doctors found that "less health literacy was associated with worse quality of life, worse physical function and more emergency department utilization for asthma over two years."

Among the many problems resulting from limited health literacy are misinterpretations of warning labels on prescription drugs. For example, among 251 adults attending a primary care clinic in Shreveport, Louisiana, those with low literacy were three times more likely to misunderstand warnings than the more literate.

When the warning label read "Do Not Chew or Crush, Swallow Whole," misinterpretations included "Chew it up, so it will dissolve" and "Don't swallow whole or you might choke."

When the warning read "Medication Should Be Taken With Plenty of Water," the mistakes included "Don't take when wet" and "Don't drink hot water."

When the warning was "For External Use Only," the mistakes included "Medicine will make you feel dizzy" and "Use extreme caution in how you take it."

Despite major reports on the need to improve health literacy issued in the last decade by organizations including the American Medical Association and the National Academy's Institute of Medicine, little improvement has been noted in how much patients understand and remember about encounters with health care practitioners.

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