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by Shanon Brantley, MCD, CCC-SLP, Arkansas State University

Communication is a complex task. Communication between healthcare professionals and patients often increases this complexity due to reduced or poor health literacy skills of patients. Health literacy refers to “the degree to which individuals can obtain, process, and understand basic health information and services they need to make appropriate health decisions” (Healthy People 2010). Approximately one-third of adult Americans, including nearly 820,000 Arkansans (37 percent) are affected by low health literacy (Bakker, Koffel, Theis-Mahon, 2017 and Coleman, Peterson-Perry, & Bumsted, 2016). Even more staggering is that 70 percent of older adults (65 yrs. and older) in the United States have low health literacy skills (Kobayashi, Wardle, Wolfe & Wagner, 2015 & Chesser, Woods, Smothers, & Rogers, 2017). The impact of low health literacy is associated with increased hospitalizations, increase use of health services, increase in medication errors, reduced compliance with health care instructions, reduced use of preventive health behaviors, increased medical expenses, and an increase in mortality rates (Hadden, 2015, National Network of Libraries of Medicine, Toronto & Weatherford, 2015).

Low health literacy in older adults is often associated with age-related changes, such as a decline in cognitive ability, hearing or vision loss, and factors of socioeconomic status (Chesser et al., 2016). However, the consequences of low health literacy in older adults are particularly crucial due to a need for more frequent health information and services because of their increasingly complicated health issues (Kobayashi et al., 2015). Due to the large population of individuals with low health literacy and its devastating effects, it is essential that healthcare professionals have adequate awareness and understanding of health literacy issues (Atcherson, Zraick, & Hadden, 2013, Coleman, Hudson, & Maine, 2013) to assist patients/clients make good healthcare decisions for themselves (Greenwood, 2017).

Unfortunately, Coleman (2011) reports that healthcare professionals have less than adequate education in the principles of health literacy. To address this issue, educators of health professions should incorporate health literacy into their educational curriculum (Hadden, 2015). However, healthcare professionals who have already “completed their education will need accessible educational programs to ensure they have the skills to identify and educate patients with limited health literacy” (Jukkala, Deupree, & Graham, 2009, p. 301). The critical need for healthcare professionals to play a role in recognizing and addressing low health literacy of their patients/clients is also evident in a statement by the Joint Commission (https://www.jointcommission.org/about_us/history.aspx) which “requires that patients not only receive but also understand information that is relative to their medical condition and care” (DeMarco & Nystrom, 2010, p. 295).

Although the U.S. Department of Health and Human Services (2010) developed the U. S. National Action Plan to Improve Health Literacy, there are currently no widely accepted guidelines on health literacy education for healthcare professionals (Coleman, Hudson, & Maine, 2013). However, some topics of health literacy that healthcare professionals may focus improvements on include: spoken communication and written communication of healthcare professionals, self-management and empowerment of patients/client, and support systems for healthcare professionals and patients/clients. Each topic is important and should be addressed to improve patients’ and clients’ health literacy. Although there are no well-established guidelines for health literacy education for healthcare professionals, there are several health literacy training opportunities for healthcare providers available online. Two common and free health literacy education resources are provided below.

The Centers for Disease Control and Prevention offers a one-hour online continuing education course accredited by the Accreditation Council for Continuing Medical Education (ACCME) titled, Health Literacy for Public Health Professionals. This course is free of charge and can be found at the following link: https://www.train.org/cdctrain/course/1057675/.
The Agency for Healthcare Research and Quality (AHRQ) division of U.S. Department of Health & Human Services offers evidence-based health literacy guidance to adult and pediatric practices through the AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition. This toolkit offers 21 tools for improving health literacy, appendices with over 25 additional health literacy resources, and a quick start guide. This guide is available to download at the following link: https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html

Health literacy can significantly affect the health status of patients and has consequently become a national concern (Hester & Stevens-Ratchford, 2009). In order to provide the best care possible for our growing population, health professionals need an appropriate understanding of key concepts affecting their care such as health literacy. Additional health literacy education and training resources are provided below to assist in improving healthcare professional’s awareness and understanding of low health literacy:

● Center for Health Literacy at University of Arkansas for Medical Sciences. http://healthliteracy.uams.edu/
● U.S. Department of Health and Human Services, Office of Center for Disease Control and Prevention – National Action Plan to Improve Health Literacy. https://health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf
● Health Literacy Tool Shed – http://healthliteracy.bu.edu/
● U.S. National Library of Medicine – Health Literacy Information Resources. https://www.nlm.nih.gov/services/queries/health_literacy.html

References:
1. Agency for Healthcare Research and Quality. (2017). AHRQ health literacy universal precautions toolkit. Retrieved from https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.htmll
2. Atcherson, S., Zraick, R., Hadden, K. (2013). A need for health literacy curriculum: Knowledge of health literacy among US audiologists and speech-language pathologists in Arkansas Education for health, 26(2), p. 85-88.
3. Bakker, C. J., Koffel, J. B., & Theis-Mahon, N. R. (2017). Measuring health literacy of the upper midwest. Journal of the Medical Library Association, 105(1), 34-43.
4. Chesser, A. K., Keene Woods, N., Smothers, K., & Rogers, N. (2016). Health literacy and older adults. Gerontology and Geriatric Medicine, 5. Retrieved from https://doi.org/10.1177/2333721416630492
6. Coleman, C. (2011). Teaching health care professionals about health literacy: A review of the literature. Nursing Outlook, 59(2), 70–78. Retrieved from http://doi.org/10.1016/j.outlook.2010.12.004
7. Coleman, C. A., Hudson, S., & Maine, L. L. (2013). Health literacy practices and educational competencies for health professionals: A consensus study. Journal of Health Communication, 18(sup1), 82–102. Retrieved from http://doi.org/10.1080/10810730.2013.829538
8. Coleman, C. A., Peterson-Perry, S., & Bumsted, T. (2016). Long-term effects of a health literacy curriculum for medical students. Family Medicine, 48(1), 49–53.
9. DeMarco, J., & Nystrom, M. (2010). The importance of health literacy in patient education. Journal of Consumer Health on the Internet, 14(3), 294–301. Retrieved from http://doi.org/10.1080/15398285.2010.502021
10. Greenwood, M. (2017). Arkansas Blue Cross launches health literacy campaign. Arkansas Blue Cross and Blue Shield. Retrieved from https://www.bcbs.com/news/press-releases/arkansas-blue-cross-launches-health-literacy-campaign
11. Hadden, K. B. (2015). Health literacy training for health professions students. Patient Education and Counseling, 898(7), 918-920.
12. Jukkala, A., Deupree, J. P., & Graham, S. (2009). Knowledge of limited health literacy at an academic health center. Journal of Continuing Education in Nursing, 40(7), 298-302-304, 336. http://doi.org/10.3928/00220124-20090623-01
13. Kobayashi, L. C., Wardle, J., Wolf, M. S., & von Wagner, C. (2015). Cognitive function and health literacy decline in a cohort of aging English adults. Journal of General Internal Medicine, 30(7), 958–964. Retrieved from http://doi.org/10.1007/s11606-015-3206-9
14. Toronto, C. E., & Weatherford, B. (2015). Health literacy education in health professions schools: An integrative review. Journal of Nursing Education, 54(12), 669–676. Retrieved from http://doi.org/10.3928/01484834-20151110-02
15. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy. Washington, DC: Author.