Strong health literacy can help patients stay informed—and make informed decisions
In the late 1990s, almost every Help Wanted ad—from corporate management to customer service to an auto body shop—included a new requirement: computer literacy. It didn’t mean you had to be an expert on computers, but you did need to know the basics of how to use one. An Ivy League education was still impressive, but without some computer literacy your resume was incomplete.
There is a new concept emerging today that similarly affects the population as a whole—health literacy. As with computers, healthcare is no longer something left only to the experts. Health choices have become part of our daily life, and anyone—no matter how educated—may feel they are back in kindergarten when it comes to certain healthcare information.
“Health literacy is a huge factor in health disparities,” says Dolores Foley, MD, of St. Joseph’s/Candler’s Primary Care in Pooler. “We deal with it every day across all kinds of socio-economic and educational backgrounds. In fact, there are a lot of very well-educated people who won’t stop and say, ‘Wait a minute, I didn’t understand that word you just said.’”
What Is Health Literacy?
The U.S. Department of Health and Human Services defines personal health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” The word “use” was added to the official definition in 2020 to emphasize a person’s ability not only to understand what they’ve learned but to apply it as well.
Dr. Foley believes that she and her colleagues are the first step in helping a patient gain command of health literacy.
“It falls on us to be mindful of the language that we’re using, how we’re describing something, and not really overwhelming people with too much information at one time,” she says. “Even with simple language, if I am talking about three or four things, that’s a lot of information. It’s difficult for anyone to keep up with that.”
After explaining the diagnosis and treatment for a patient’s problem, Dr. Foley will often ask the patient to explain it back to her to make sure it stuck. She will also write down changes in medications or new instructions, so that the patient has a physical source to which they can refer. Also, she encourages patients to ask her to slow down or even stop her if there is something they don’t understand.
“I want to explain the information in such a way that you can go home and tell a family member what I told you, and they understand it too,” she says. “Otherwise, I consider it an ineffective visit.”
Ownership Can Even Be Wallet Size
One of the biggest gaps in health literacy that Dr. Foley has seen with patients is with medications.
“A new patient might tell me they have high blood pressure and diabetes, but if I ask what medications they are on, they can’t tell me,” Dr. Foley says. “I will learn all of these things about my patients, of course, but what if they find themselves in the emergency room and can’t tell their ER doctor what medications they take?”
Dr. Foley concedes that many medication names are “ridiculously long and make no sense,” but she encourages patients just to copy what’s on the label to a slip of paper that they can carry in their wallet. You can even simply take a picture of your prescription bottles and keep that stored on your phone.
“You don’t need to know a whole lot about the medication,” she says. “I don’t ask my patients to dig deep into that. But there does need to be some ownership on each side.”
Peace of Mind or Pitfall?
The other important factor in health literacy is how and where patients find the information. Being able to input symptoms into a search engine such as Google or Bing, resulting in an abundance of articles and information, has both benefits and disadvantages.
“I don’t mind that people look stuff up before they come in—in fact, I like it,” Dr. Foley says. “It gives people a chance to think about what they want to talk about when they come in. It also gives patients a sense of control and some prior knowledge, so that they can have an educated discussion.”
The problem with popular search engines is that many of the results are not evidence-based and often aren’t generated from the medical field. This can lead to misunderstandings that Dr. Foley then has to help correct during the appointment, which can take a chunk of the already-limited time. Another issue is that a collection of symptoms can lead to wildly-varying results—a patient’s ear infection may share symptoms with something rare but life-threatening such as a brain tumor.
“Many times, what comes up online just says ‘cancer,’” Dr. Foley says. “That doesn’t help people understand the problem that they have. And instead of peace of mind, they get anxiety.”
Since the internet isn’t going away, Dr. Foley hopes that patients will use it to strengthen their health literacy, in conjunction with listening to their doctor.
“This is all about interaction and discussion, and we just have to be sure we’re discussing things in the appropriate way,” she says. “That also includes stopping me if you don’t understand what I’ve said. I won’t take offense. I’m thrilled that you are invested in your health.”