Health literacy

Amongst scholarly journals, authors are commonly encouraged to communicate with their peers in simple language and to avoid jargon, abbreviations and overly complex language. How much more important is communication with recipients of health care, where misunderstandings might result in, at the least, no improvement in health and, at worst, admission to hospital or life-threatening situations. Health literacy is ‘the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions’. Health literacy requires a complex group of skills that include ‘the ability to interpret documents, read and write prose (print literacy), use quantitative information (numeracy) and speak and listen effectively (oral literacy)’. Health literacy is essential as our health care moves away from a paternalistic model to one increasingly directed towards a partnership between patient and health-care provider. This partnership will be influenced by the level of health literacy of the patient, carer and health-care provider and the degree to which all partners are ‘on the same page’ or at least can find an effective way to communicate both health seeking and health providing behaviours. Low levels of health literacy (print or oral literacy or numeracy) are associated with higher risk of death, more frequent hospitalizations and higher use of health-care services. The most recent American assessment of health literacy highlighted a number of vulnerable groups: (1) older adults (>65% of people aged 65 and older have difficulties using print materials including charts and forms and performing calculations and interpreting numbers); (2) immigrants (lower health literacy associated with speaking a language other than English before commencing school); and (3) people with low income living below the poverty threshold. As in other patient populations, levels of health literacy are variable amongst people with chronic obstructive pulmonary disease (COPD). However, it is likely that the proportion of people with low health literacy is relatively high in the population of people with COPD as they are older population with a lower average socioeconomic status, both of which are key contributors. Low health literacy might lead to the misunderstanding of instructions, which can impact on adherence to medical interventions. This was dramatically illustrated by Davis et al., who reported that just over a third of patients with low literacy were able to show how many tablets should be taken when given a written label containing the instruction ‘Take two tablets by mouth twice daily’. Existing health literacy tests can be time consuming. Simply asking patients about their education attainment is not sufficient, as the highest grade of education completed is often higher than the actual level of literacy. Whilst there are some health literacy tests that are easy to administer (e.g. Rapid Estimate of Adult Literacy in Medicine (REALM)), patients often feel awkward or embarrassed in providing truthful responses. Whereas not as accurate as the REALM, several studies have confirmed that asking a single question ‘How confident are you filling out medical forms by yourself?’ may be useful for detecting patients with inadequate health literacy. In the absence of screening, experts encourage health-care professionals to assume that all patients have low health literacy – ‘the lowest common denominator’. When using this approach, however, it is almost inevitable that patients with higher literacy