Health Literacy

A report from the Agency for Healthcare Research and Quality updates earlier work on the impact of health literacy on health care and health.  Health literacy is defined as the ability to obtain, process and understand health information, particularly in the context of making health-related decisions.  It includes the ability to read and understand documents, to absorb verbal information, communicate decisions or questions effectively and to understand quantitative information.  The report consists of a typical review of all studies relating to the topic, culling of conclusions from these studies and a grading of the evidence.   (AHRQ Report)

As might be expected, lower levels of health literacy are associated with poorer health outcomes and more use of health services, although the evidence for these effects is not always strong.  In terms of service use, lower health literacy was associated with increased hospitalization, greater ER use, and lower rates of mammography and receipt of flu vaccine.  Among seniors, low literacy was correlated with poorer health status and greater mortality.  Patients with low health literacy were less likely to take their medications properly and had more trouble interpreting labels and health messages.  There was insufficient evidence to draw any firm conclusions about a relationship between literacy and costs.

Studies relating to interventions to improve health literacy or ameliorate its effects were also examined.  These largely dealt with alternative document design, using pictures and making information more readable.   There was only moderate evidence that these interventions improved comprehension, changed health service use or improved outcomes.  Health literacy rather obviously most likely reflects the educational status of a patient as well as their overall sense of self-confidence and responsibility.  It is important to focus on if you believe that having patients involved in decisions about their care and able to communicate their preferences effectively is a key to better quality and lower costs.