Health Literacy Is a Social Justice Issue That Affects Us All

[ILLUSTRATION OMITTED] Health literacy is often defined as the ability to read, understand, and act on health care information. It entails the ability to perform basic reading and numeric tasks in the health care context, including comprehending prescription labels, appointment slips, insurance forms, and other health-related information distributed to patients (Andrus & Roth, 2002; Kirsch, Jungleblut, Jenkins, & Kolstad, 2002; Kutner, Greenberg, & Baer, 2005; Schillinger et al., 2003). Zarcadoolas, Pleasant, and Greer (2005) propose an expanded model of health literacy in which the concept refers to a "wide range of skills, and competencies that people develop to seek out, comprehend, evaluate and use health information and concepts to make informed choices, reduce health risks, and increase quality of life" (p. 196). Patients with low health literacy have difficulty with written and oral health communications that can limit their understanding and retention of the information provided to them (Davis, Williams, Marin, Parker, & Glass, 2002; Williams et al., 1995). Patients with low literacy have more difficulty naming their medications and may hold health beliefs that can interfere with taking them correctly (Schillinger et al., 2003). Low health literacy can impair communication regarding risks and benefits of treatment options (Davis et al., 2002), which is especially critical in the management of chronic diseases because patients "typically must cope with complex treatment regimens, manage visits to multiple clinicians, monitor themselves for changes in health status, and initiate positive health behaviors" (Schillinger et al., 2003, p. 84). As our population ages, chronic diseases such as hypertension, diabetes, osteoporosis, and heart disease are becoming more prevalent. There are several problems with definitions of health literacy that are found within the medical literature (Cuban, 2005; Greenberg, 2001). They tend to ignore cultural differences, as well as health beliefs and practices that are rooted in culture. Definitions of health literacy often do not address the "receptive and oral communication skills that are necessary to navigate the health environment" (Greenberg, 2001, p. 70), which may lead to a patient not knowing what information is important to share with a physician or understanding how to adhere to medical instructions, which are based on assumptions patients may not share. The needs of English language learners are often not recognized by medical professionals, nor are the difficulties addressed that many patients have with medical vocabulary, no matter their educational level. Patients are often reluctant to reveal their low literacy to medical providers, and few health professionals have received training in how to detect potential literacy problems. Patient education literature historically has placed the onus for understanding on patients rather than perceiving health communications as a shared responsibility. Nevertheless, patient education efforts often rely on a deficit model in which low functional health literacy is "equated with limited compliance with the heath care system, with treatment plans, and minimal lifestyle change" (Cuban, 2005, p. 104). Patients are expected to learn topics and behaviors that are provider-defined, rather than heath care professionals taking the time to determine a patient's knowledge level (Greenberg, 2001; Wise & Owens, 2004). Patients are increasingly being asked to take more responsibility for self-care in a complex health care system, and this can be a challenging prospect for even the most educated. Patient education materials are an important source of health care communications on medical treatment and health behaviors, but their value depends on how accessible and useful patients find them. Information can play an important role in fostering patients' self-care behaviors (Wilson, Baker & Brown-Syed, 2000), yet many health-related materials are written well above the average reading ability of many adults (Clerehan, Buchbinder, & Moodie, 2005; Estey, Musseau & Keehn, 1991; Schillinger et al. …