Feb. 27, 2007

AMARILLO – If you've ever ended a conversation with a health care provider just as confused as you were at its beginning, you know why health literacy is so important. That's the word from Andrew Crocker, Texas Cooperative Extension gerontology specialist.

"The U.S. Department of Health Human Services Health Resources and Services Administration defines health literacy as ‘the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions,'" Crocker said.

Even though that definition itself is a little difficult to understand, it also misses a key element, he said.

"Health literacy also depends on the ability of the health provider to communicate information regarding health issues," he said. "The ‘individual' – or patient – is only part of the equation."

Although the cause of health illiteracy is a mystery, Crocker said rapidly increasing technology could be a factor.

"Medicine and health information have come a long way in a relatively short time," he said. "New medications (and) procedures are developing daily, involving more and more complex methods."

The limited amount of time health care providers have to spend with each patient also contributes to the problem, he said.

"Often information is given without further consideration of whether or not it was comprehended," Crocker said. "Many people still see their health provider as unapproachable when it comes to questions because of the speed with which he or she completes their office visit."

Why is this such an important issue? Because miscommunication between patient and doctor can have serious consequences, he said.

"Individuals with limited health literacy incur medical expenses that are up to four times greater than patients with adequate literacy skills, costing the health care system billions of dollars every year in unnecessary doctor visits and hospital stays," Crocker said.

Not only that. Many of these patients hide their confusion from their doctors because they are too ashamed and embarrassed to ask for help, according to the American Medical Association Foundation.

The problem is widespread. A recent government study estimated that more than 89 million adults from all ages, races and income and education levels have limited health literacy skills, Crocker said.

Fortunately this is a problem with a simple cure: Ask questions, he said.

"Many adults who have low literacy – health or otherwise – are often ashamed of this fact and try to put on a ‘show' for their health provider," Crocker said. "The health provider should be the first stop for terms, names, instructions or other words and phrases that the patient doesn't understand. If the provider is unable to satisfactorily explain what something means, then someone else from the office – a nurse or assistant – should be asked to explain things."

The patient might want to consider writing down any information from the health care provider and reading it back to make sure it's correct. Dictionaries of medical terminology, which are available at bookstores, might also be helpful, Crocker said, although the language is often technical.

Internet sites may have useful information too, but each site "should be evaluated for credibility prior to accepting it as fact," he added. Check for author, source, sponsor and date of publication.

All the responsibility for health literacy isn't on the patient, Crocker said. Doctors and other health providers need to provide their part too.

He offered steps doctors can take to help the situation:

- Use simple language in short sentences and define technical terms.

- Use videos, pictures or other visual aides if necessary.

- Ask patients to repeat instructions.

- Ask ‘how' and ‘what' questions instead of ‘yes' and ‘no' ones.

- Provide the most important information first.

- Keep in mind the age, culture, ethnicity and racial background of each patient.

- Provide information in the patient's primary language.

Some hospitals and health care providers follow the Patients' Bill of Rights, Crocker said, which begins, "You have the right to receive accurate and easily understood information about your health plan, health care professionals and health care facilities. If you speak another language, have a physical or mental disability or just don't understand something, assistance will be provided so you can make informed health care decisions." ( http://www.consumer.gov/qualityhealth/rights.htm )

"However, this is only as good as the patient makes it," Crocker said. "That part about ‘assistance will be provided' only counts if the patient asks. The patient doesn't need to try to be ‘good' by acting like they understand information if they don't. If their health provider doesn't have the time or desire to answer their questions appropriately and ensure that they understand the information, maybe it's time to find a new health provider."