2016-08-02 15:34:36 UTC

Health Literacy is a Crucial Component of Patient Care

Aug. 8, 2016

Dr. Darrell Gray describes how AGA's new patient education materials can be used as a first step in using health literacy to your advantage.

By Darrell M. Gray, II, MD, MPH, The Ohio State University Wexner Medical Center, Columbus, OH

It’s Friday afternoon at 4 p.m. and Mr. Anderson walks into your endoscopy suite as your last patient of the day. He’s a 65-year-old, publicly-insured male who presents for a screening colonoscopy. He’s 20 minutes late because he went to registration in the surgery department. He is convinced “looking for cancer” requires surgery. In triage, the nurses learn that he has held his Coumadin for five days as personally instructed by his cardiologist, but that he did not follow instructions for adequate bowel preparation and hence is still passing light brown stool. Upon further questioning, the nurses also learn that he did not understand the mailed educational materials on bowel preparation from your center. Mr. Anderson has to be rescheduled. He’s frustrated. He took time off from work, stopped his Coumadin and believes his instructions weren’t clear. You’re frustrated too; you’re not sure if Mr. Anderson will return for the necessary screening, and you recently had a talk with your administrator and recognize your patient satisfaction scores and RVUs are under the microscope. What’s even more frustrating is that you know that this could have been prevented if Mr. Anderson had access to educational materials tailored to those with low health literacy.

How much thought do you give to health literacy? It is how patients obtain, process and understand basic health information services, which enables them to make better health decisions. Populations at highest risk to experience low health literacy include adults older than 60, people with low income, racial and ethnic minorities, and those who speak English as a second language. Contrary to common belief, health literacy is less associated with standard literacy and education levels. Even more surprisingly, only 12 percent of adults are proficient in health literacy, according to the National Assessment of Adult Literacy. Therefore, even your most “educated” patients may not understand or process health information appropriately to manage their conditions. 

According to NIH, health materials should be written at a seventh or eighth grade reading level; however, researchers at Drexel/Hahnemann University Hospital found that most GI patient materials on the Internet are written above an eleventh grade reading level. As health-care providers, we have a duty to ensure that we provide high-quality care in a way that our patients can understand, engage in the management plan and act on their own outside of our office walls. 

AGA’s new patient engagement materials, found in the PatientINFO Center, were written at the lowest reading levels possible. Though some of the materials may seem basic, they present complicated health information that is useful and actionable for our patients. Remember that just because a patient nods along to your recommendations or says they have no questions at the end of a visit doesn’t mean they are equipped to take on disease management or procedure preparation on their own. Supplying them with instructions and educational materials at proper reading levels is one step we can all easily take to create safe spaces for open conversations during our limited time together.

There are a lot of misconceptions about health literacy, but its positive impact on us as physicians and on patient care is undeniable. It’s time we harness the power of health literacy, learn more and use it to empower those we care for. Check out the new AGA patient education materials written at low reading levels as a first step in using health literacy to your advantage. 


How to Write Easy-to-Read Health Materials: MedlinePlus. (n.d.). Retrieved July 29, 2016, from https://medlineplus.gov/etr.html

Health Literacy - Fact Sheet: Health Literacy Basics. (n.d.). Retrieved July 29, 2016, from http://health.gov/communication/literacy/quickguide/factsbasic.htm 

Patel, SR, et al. Health Literacy and Gastroenterology: A Quantitative Readability Analysis of Patient Education Materials on the Internet. Poster session presented at: ACG 2015. The American College of Gastroenterology Annual Scientific Meeting and Post Graduate Course; 2015 Oct 16-21; 

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