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Health Literacy Part 1

Posted Dec 09 2011 5:32pm

This comes from the wife of a co worker who gave me permission to share with the Health and Wellness community. Thank you in advance for allowing me to share such a great article.


Health Literacy: Improving Patient Outcomes Through Nursing Education


Tracy W. Dustin, BSN, RN

A thesis submitted in partial fulfillment

of the requirement for the degree

Master of Science in Nursing Education


Westminster College

Salt Lake City, Utah


December 2010




The topic of health literacy has captured the attention of the public, many disciplines within public health, as well as other health professionals. This state of the science literature review paper presents a summary of background information, recent statistical review, effects on patient outcomes, and other research pertaining to the topic of health literacy. Electronic database searches and journal reviews were conducted to collect this data. Articles reviewed for this paper unanimously agree that the topic of health literacy should be included as a part of all health education curriculums; however, the articles do not provide any suggestions as to the process of implementing this education into academia or clinical settings. This review concentrates on the nursing discipline and shows that there is insufficient education on this topic in nursing schools and in the nursing field as part of continuing education. Suggestions for college curriculum and nursing staff development are outlined in the recommendations portion of this review.


Keywords: health literacy, nursing education, curriculum, continuing education, medication literacy, health outcomes, reading level


I would like to extend my thanks to Jannette Publications, Blackwell Publications, and Commonwealth Fund for granting permission to reference their work.



Health Literacy: Improving Patient Outcomes Through Nursing Education

“If you can’t explain it simply, then you don’t understand it well enough.”

—Albert Einstein


Health literacy is defined by the U.S. Department of Health and Human Services as “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness” (Weiss, 2003, p. 6). According to Parker et al. (2003), people with adequate health literacy seek care earlier, read and understand instructions, understand and carry out what their doctors have advised, are not afraid to ask questions, are able to seek out new information through use of modern technical devices such as the Internet, and are able to read information with a critical eye.

Unfortunately, there is a significant problem with adequate health literacy in the United States, and the ensuing consequences continue to expound. The magnitude of low health literacy is of great concern in this country because it leads to poor health outcomes and significant economic consequences. The cost of excess hospitalizations alone, which is attributed to low health literacy, is estimated to be between $8 and $12 billion per year (Arozullah et al., 2006).

This state of the science literature review paper was conducted with the purpose of presenting a summary of background information, recent statistical review, effects on patient outcomes, and other research pertaining to the topic of health literacy.

The American Medical Association Foundation (AMAF) reported that health illiteracy affects more than 89 million Americans (American Medical Association, 2010), and is considered a crisis. The National Center for Education Statistics released a study in 1993 and then again in2005 indicating that approximately 50% of American adults lack basic health literacy skills (Rudd, 2007). Half of the adult population can neither read nor understand basic health information and are therefore unable to properly navigate the health care system. The problem is worsening as technology and health products continue to become more complicated. As health literacy is directly correlated to health status, the United States adult population is experiencing a rise in poor health outcomes, which in turn leads to an astounding increase in health care costs (Von Wagner, Steptoe, Wolf & Wardle, 2009). Many of these costs are attributed to the lack of basic literacy skills.

In order to function within the current health care environment, basic reading and numerical skills are essential (Institute of Medicine, 2004). Most health information is written with a level of complexity that even people with a college education struggle to understand. This is due in large part to the disparity between the reading comprehension levels of most patients as compared to the reading level with which most health care information is published. Medication labels and instructions add to the disparity, thus leading to patients who are unable to adhere to prescribed drug regimens (Tkacz, Metzger, & Pruchnicki, 2008). It is an ongoing challenge that is expected to only worsen.

Over the years, the health care system has changed significantly, having grown increasingly complex and increasingly technical (AMAF, 2006). This consequently leads to a health illiteracy crisis as more and more patients are unable to understand basic health information (Bastable, 2008). As a result, low health literacy skills have been linked by recent studies to undesirable health outcomes and long-term negative health consequences as patients are expected but unable to understand and carry out complicated health instructions (Albright et al., 1996). These outcomes include but are not limited to delayed diagnoses, poor disease management skills, higher health care costs, low medication compliance, and higher risk of hospital readmission (Schwartzberg, Cowett, VanGeest & Wolf, 2007).

The populations that are most at risk of having poor health outcomes are the elderly, the undereducated, those with a low income level, and certain ethnic groups (Gazmararian, Baker, & Williams, 1999).

One of the factors adding to the complexity of health literacy is that adults with low literacy skills do not typically disclose their problems to family members or health care providers. Admitting to health literacy issues brings too much shame and guilt to an already complicated issue (Parikh, Parker, Nurss, Baker, & Williams, 1996). In addition, health care providers are not taking the time to ensure their patients understand information because of imposed time constraints. In actuality, however, it only requires a very slight change in patient teaching practice to make a big difference in patient satisfaction and understanding (AMAF, 2007).

It is imperative that nurse educators help staff and student nurses become aware of health literacy issues. They need to know what constitutes “best practice” with regard to health literacy in order to facilitate better health outcomes for patients. For the medical establishment, teaching about health literacy is not just about saving money; it is about alleviating fear and anxiety amongst patients. It is about making patients feel that they are in charge of their health and are not just simply bystanders. There is a high cost attached to health illiteracy, and health care providers need to be advocates for their patients and for system changes in advancing the issue of health literacy. As described above, “Health literacy is a safety issue, a financial issue, an access issue, a fairness issue, a communications issue, and a time management issue” that ultimately affects how patients are cared for in the United States (AMA, 2006, p. 5).

The purpose of this paper is to suggest methods that will bring awareness of health literacy issues to nursing staff and give them tools to better educate theirpatients, thus promoting better health outcomes. As health and staff educators, we have the ethical responsibility to provide the proper training to nursing staff regarding health literacy issues, ultimately impacting the safety of patients. In addition to identifying health literacy issues, solutions will also be outlined for properly educating patients so they understand the health information that they receive.


End of Article 1.



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