“The ability to obtain, process, and understand health information and services to make appropriate health decisions.” (Healthy People 2010)
Health literacy is not simply the ability to read. Health literacy requires a complex group of reading, listening, analytical, and decision-making skills and the ability to apply these skills to health situations.
Patients with adequate health literacy can:
Patients are often required to carry out specific tasks when they faced with complex information and treatment decisions. These tasks includes evaluating information for credibility and quality, analyzing relative risks and benefits, calculating dosages, interpreting test results, or locating health information. In order to accomplish these tasks, individuals may need to be:
Oral language skills are important as well. Patients need to articulate their health concerns and describe their symptoms accurately. With increasing needs for shared decision-making between clinician and patient for health care, patients need strong decision-making skills. Health literacy may also include the ability to search the Internet and evaluate web sites since the Internet becomes important source of health information.
Health literacy is measured in terms of grade level-the average reading skill achieved at each year of schooling in the American public school system. A person who can read at the 5 th grade level or higher is considered literate. A person who can read at less than 6 th grade level is sometimes referred to as functionally illiterate ( Doak, Doak & Root, 1996).
An alternative method of defining literacy skills is functional competency levels. This method measures people’s ability to perform literacy tasks needed to fully participate in society. Functional competency is assessed through reading, writing, and computing tests which are then grouped into levels, with level 1 being the lowest functioning and level 5 being the highest. Functional competency levels are used in U.S. government literacy surveys (e.g. National Assessment of Adult Literacy, NAAL) and are becoming more popular than traditional "grade levels" for assessing health literacy.
These two literacy measures, grade level and functional competency, use different criteria and there is no conversion between them. However, as a rough approximation, those who read below 5 th-grade level correspond with those whose literacy skills fall in level 1 in terms of functional competency in literacy tasks.
According to the 1992 National Adult Literacy Survey (NALS), some 40 to 44 million of the 191 million adults in the country are functionally illiterate. They read at or below a fifth-grade level, or cannot read at all. Another 50 million are marginally illiterate. They are generally able to locate and assimilate information in a simple text, but are unable to perform tasks that require them to assimilate or synthesize information from complex and lengthy texts ( Kirsch, Jungebut, Jenkins & Kolstad, 1993 )
In average adult patient population ( Doak, Doak, & Root, 1996)
In community-dwelling Medicare enrollees in a managed care organization (Gazmararian, Baker, Williams, et al., 1999)
In a 1995 study of two public hospitals (Williams, Parker, Baker et al., 1995)
According to the Center for Health Care Strategies, although the population most affected by literacy comprises native-born, White Americans, a disproportionate number of minorities and immigrants are also estimated to have literacy problems (Potter & Martin, 2005)
The relationship between literacy and health is complex. Literacy impacts health knowledge, health status, and access to health services. The results of the 1992 Adult Literacy Survey (National Center for Education Statistics, US Department of Education) indicate that adults with low literacy were more likely than those with higher literacy levels to be poor and to have health conditions which limit their activities. There are both direct and indirect consequences of low health literacy. The direct effects include non-compliance or medication errors. The indirect effects are harder to measure, but may include insurance issues, accessibility to healthcare, and poor health behavior choices.
People with low literacy:
Low health literacy is an enormous cost burden on the American health care system, estimated to cost tens of billions of dollars annually. Annual health care costs for individuals with low health literacy skills are four times higher than for those with higher health literacy skills (Hohn, 1998).
The National Academy on an Aging Society estimated that additional health care costs due to low health literacy were about $73 billion in 1998 dollars. This includes an estimated $30 billion for the population that is functionally illiterate, plus $43 billion for the population that is marginally literate. (Health Literacy Fact Sheet, National Academy on an Aging Society). The findings of their study showed that: