Chapter 6: Literacy and Health Literacy

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Literacy and Health Literacy

Culturally Effective Care Toolkit – Chapter 6

​​​​​​Health literacy has been defined as "the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness". Patients with a low literacy level may have difficulty understanding verbal and written instructions, understanding and managing chronic diseases, completing medical history or insurance forms, accessing health care services, and understanding the importance and consequences of high-risk behavior. Studies have demonstrated an association between high literacy level and knowledge of the use of health services such as emergency department instructions, childhood health maintenance procedures, and informed consent. Additionally, researchers have identified a positive relationship between high literacy level and knowledge of asthma, HIV/AIDS, postoperative care, and others (​).

Assessment of Liter​acy Levels

To determine a patient's or family's health literacy level, providers can use one of many assessment tools. The severity or chronic nature of the patient's clinical scenario are factors that modulate the emergent need for health literacy assessment and the long-term effect of literacy level on medication adherence, disease management, and ultimately, health outcomes. Because health literacy involves not just patients' ability to read but also to understand messages relating to health and health care, providers should assess all patients' health literacy levels to provide the best care. Pediatricians need to communicate with all patients and parents, but particularly those with low literacy, at a level they can understand. Specific communication techniques such as asking the parent to say in their own words what they understood and posing inviting questions to the family are encouraged.

Chapter 6 Tools ​and Resources

Tool 6A: AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition.
This toolkit provides evidence based guidance to adult and pediatric practices to ensure that systems are in place to promote better understanding by all patients. 21 tools to improve spoken communication, written communication, self-management and empowerment, and supportive systems are included.

Tool 6B: Health Literacy Assessment Tool: Rapid Estimate of Adult Literacy in Medicine (REALM) 
The REALM is a medical-word recognition and pronunciation test for screening adult reading ability in medical settings. It can be administered and scored in less than 3 minutes by personnel with minimal training, making it easy to use in clinical settings. It is available in English only. There is a cost associated with administering this tool.

Tool 6C: Health Literacy Assessment Tool: Test of Functional Health Literacy in Adults (TOFHLA)
The TOFHLA includes a 17-item test of numerical ability and a 50-item test of reading comprehension. It takes up to 22 minutes to administer. It is available in English only. There is a cost associated with administering this tool.

Tool 6D: Institute of Medicine: Healthy Literacy: A Prescription to End Confusion Literacy Consensus Report Brief​ and Full Report

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shopAAP Resources

Plain Language Pediatrics: Health Literacy Strategies and Communication Resources for Common Pediatric Topics (2008). AAP. Abrams MA, Dreyer BP, eds. Elk Grove Village, IL: American Academy of Pediatrics

This book provides the framework for implementing a plain language approach to communication in your office and specific steps you can take to ensure the information you present to patients and their parents is clearly understood. Included are 25 reproducible plain language patient education handouts in English and Spanish. 

Health Literacy Strategies to Enhance Communication, PediaLink Course
The goal of this course is to increase awareness of health literacy among pediatric healthcare providers and its impact on the healthcare system.