Healthcare professionals are notorious for throwing around complex medical concepts and jargon that confuses patients rather than helping them understand what's happening to them. This tendency shows poor communication skills that erode patient trust and contribute to lower adherence, worse health outcomes, and increased health disparities.
Cultural competency, with an emphasis on clear communication, helps healthcare professionals communicate better with all patients, including those with lower levels of health literacy, for stronger relationships and improved patient satisfaction.
Health literacy is defined as an individual's ability to obtain, interpret, and understand essential medical information to make informed healthcare decisions.
For more on the definition of health literacy and ways to address it in clinical practice, read our blog post, "What Is Health Literacy and Why Is It So Important?"
Expanding the definition of health literacy
More recently, health literacy has been further characterized as comprising not only personal health literacy as defined above, but also digital health literacy, numeracy, and organizational health literacy.
- Digital health literacy refers to an individual's ability to use electronic sources for health information.
- Numeracy is the ability to understand numbers and data relevant to health care, such as measurements, dosages, and risks.
- Organizational health literacy concerns a healthcare organization's ability to provide accessible and understandable health information to all patients, regardless of their health literacy level.
Impact of health literacy on health outcomes
Health literacy has a huge impact on health outcomes. Compared to patients with adequate health literacy, patients with low health literacy have:
- Less knowledge about their medical conditions
- Less use of preventive health services
- Poorer control of chronic diseases such as hypertension and diabetes, and
- Higher mortality
This constitutes a disparity for those with lower health literacy. While health literacy is cited as a cause of racial and ethnic health disparities, its direct contribution to these disparities is a complex question.
Health literacy and health disparities
Statistics show that demographic groups facing health disparities, such as older adults, low-income and low-education individuals, racial and ethnic minorities, and non-English speakers, often have lower health literacy. For example, in one national assessment, 58% of African Americans and 66% of Hispanic/Latinos (including those who speak English well) had basic or below basic health literacy, compared with 28% of non-Hispanic Whites (Kutner et al., 2006). Based on these data and the known poor outcomes for patients with low health literacy, it seems intuitive that low health literacy would contribute to racial/ethnic and linguistic disparities in health. However, it is more difficult to prove this with specific research studies.
Linking health literacy with racial/ethnic disparities
Many studies have looked into how much health literacy, or the lack thereof among disadvantaged groups, plays a role in racial/ethnic health disparities. This research aims to show exactly how health literacy affects these health disparities.
One review article examined 36 studies designed to answer this question and found mixed results. For example, there was evidence that low health literacy (and numeracy) contributed to racial/ethnic disparities in medication adherence and self-reported health status. However, many of the other studies reviewed did not show compelling evidence for the role of health literacy in health disparities. This would suggest that other factors besides differences in health literacy are more important drivers of racial/ethnic disparities.
Health literacy is an essential issue for all patients, including those suffering from health disparities. However, the available studies have yet to make a direct connection. More research is needed, particularly well-designed studies that hypothesize a causal pathway and focus on a particular disparity for a particular group.
Future directions in health literacy
Addressing health disparities and health literacy for disparity groups are both critical areas for intervention to improve population health overall. Healthcare professionals should be trained in how to communicate at a level that is understandable to patients with a wide range of health literacy levels. This includes:
- Avoiding medical jargon and complex terminology
- Using the teach-back method to ensure comprehension
- Breaking down information into smaller bits rather than trying to convey multiple ideas simultaneously
Organizational health literacy should also be prioritized so that healthcare organizations are held accountable for universal health literacy precautions to ensure that all patients receive comprehensible health information.
These and other suggestions are outlined further in the Quality Interactions blog post, "What Is Health Literacy and Why Is It So Important?" and in various Quality Interactions courses.
