A young man takes two tablets daily for an illness on the advice of his doctor. Yet, when he returns for a repeat visit, his condition has worsened. The doctor is perplexed until learning, after some difficult questions, that the young man stopped taking the tablets. They upset his stomach when he took them together every morning. The tablets were supposed to be taken separately, one in the morning and one in the evening.
This type of scenario occurs more often than you might think, and for a variety of reasons.
Health literacy is an important component of our overall health and well-being. It helps us not only when we visit a doctor, but also when we use it to prevent illnesses or injuries and to promote healthy behaviors. During this October Health Literacy month, we should try to understand what health literacy is and how we can enhance it.
What is health literacy?
The U.S. government’s Healthy People 2030 initiative addresses both personal health literacy and organizational health literacy with the following definitions:
Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
These definitions emphasize people’s ability to use health information rather than just understand it and acknowledge that organizations have a responsibility to make health information accessible and readily understandable for patients so that they can participate more fully in their own health care.
Many reasons contribute to miscommunication in healthcare settings. Some of these include:
- Pressure on healthcare providers to see patients quickly;
- Lack of familiarity with strategies to communicate clearly and confirm comprehension;
- Use of medical terminology;
- Limited English proficiency combined with lack of qualified interpreter services;
- Unrecognized low literacy among patients
- Anxiety around medical visits and having to make decisions based on limited information;
- Complicated bureaucracies for accessing and paying for services;
- Cultural misunderstandings or assumptions among both patients and healthcare providers.
The Centers for Disease Control and Prevention defines Culture as group membership, such as racial, ethnic, linguistic, or geographical groups, or as a collection of beliefs, values, customs, ways of thinking, communicating, and behaving specific to a group.
How can we improve health literacy?
Educators can ensure that the information given to patients – care instructions, pamphlets, brochures, signage at doctors’ offices – is presented in ways that is not only accurate, but also understandable by the intended audience.
For example, one of SAMHSA’s most popular series is a set of short factsheets for teenagers called Tips for Teens, produced by SAMHSA’s Center for Substance Abuse Prevention. Each sheet provides facts about a particular substance – such as inhalants or methamphetamines – the slang or street names for the product, the appearance of the substance, signs of use, short- and long-term effects, and actions to take to help oneself or a friend.
Useful tools for educators include the Toolkit for Making Written Material Clear and Effective, from the Centers for Medicare & Medicaid Services and the Patient Education Materials Assessment Tool (PEMAT) and User’s Guide from the Agency for Healthcare Research and Quality.
Healthcare providers and administrators can pursue several strategies to avoid miscommunication with diverse patients. These include 1) offering language assistance to patients – at no cost – who have limited English proficiency; 2) recruiting and retaining culturally diverse individuals responsive to the population within their service area in their workforce and in leadership positions; and 3) establishing regularly scheduled trainings to increase the capacity of staff to provide services that are culturally and linguistically appropriate. The Health Literacy Universal Precautions Toolkit, 2nd Edition, Encourage Questions: Tool #14 gives healthcare providers clear and concise steps they can take to elicit questions from patients.
Consumers of healthcare services can actively seek information from libraries and websites, ask questions of healthcare providers, and learn to ask them in ways that elicit the information they need. The QuestionBuilder App and related Question Builder Online – also available in Spanish, QuestionBuilder en Español – help patients and their families formulate questions that can help them take better care of themselves. For example, questions may include: “Will this medicine interact with medicines that I'm already taking?” “Why do I need this treatment?” “Are there any alternatives?”
Increasingly, providers of services for mental and substance use disorders are recognizing the value of the National CLAS Standards (PDF | 77 KB) in advancing behavioral health equity. In support of this, SAMHSA collaborated with Office of Minority Health to develop the Behavioral Health Implementation Guide for the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (PDF | 408 KB).
These documents provide concrete, feasible implementation strategies for the health and behavioral healthcare community to improve the provision of services to all individuals, regardless of race, ethnicity, language, socioeconomic status, and other cultural characteristics.
Going forward, SAMHSA will continue to promote health literacy to enhance the goal of advancing health equity, improving quality, and eliminating health care disparities in the treatment of mental and substance use disorders.
SAMHSA offers tools and publications to enhance understanding of mental and substance use disorders:
Building Recovery Supports to Scale (BRSS TACS) offers shared decision-making tools that help people in treatment and recovery work together with their providers to make the best plan for their needs and situation.
The Evidence-Based Practices Resource Center provides communities, clinicians, policymakers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings.
The SAMHSA Store offers a wealth of free publications and digital products offering information on treatment for mental and substance use disorders, substance use prevention, and mental health promotion.
Find Treatment provides phone is a guide that helps professional numbers and websites to obtain help.
TIP 59: Improving Cultural Competence care providers and administrators understand the role of culture in the delivery of services for mental and substance use services.
MyHealthFinder provides plain language information on recommended prevention and screening services.