What is Health Literacy?

Health literacy is defined 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. The concept of health literacy differs from literacy itself. Health literacy requires basic reading skills, but also the ability to understand oral communication, use numbers and math skills, understand how to navigate the health system on a basic level, as well as the ability to communicate with health care providers and their staff. These skills are imperative for patients to be able to do the following:

  • Communicate health problems to their providers and understand health information
  • Read prescription bottles and understand treatment regimens
  • Read and understand warning labels to recognize potentially life-threatening complications from medications
  • Implement self-care strategies and manage their health at home
  • Read and understand health insurance forms, informed consent, and public assistance applications

The Problem of Health Literacy

Millions of Americans lack adequate literacy and numeracy skills. The 2003 National Assessment of Adult Literacy (NAAL) revealed that 93 million American adults – 43% of the adult population – have basic or below basic literacy as compared to intermediate or proficient levels. People with basic or below basic literacy generally have difficulty performing tasks like reading a bus schedule or bar graph, or writing a simple letter explaining an error on a bill. The problem of inadequate literacy is especially pronounced in North Carolina. Based on the 1992 NAAL survey, more North Carolinians function at the lowest literacy levels compared to people nationally. State level estimates place North Carolina 41st in terms of adequate adult literacy levels. The 1992 estimate likely underestimated the current problem of health literacy in this state as the population of immigrants and elderly continues to grow.

Research indicates that low health literacy contributes to a number of health and health care problems. Low health literacy is associated with:

  • Lack of knowledge and understanding about health conditions and services
  • Inability to implement appropriate self-care activities
  • Difficulty understanding medication instructions and adhering to treatment
  • Lower utilization of preventive care and services
  • Increased hospitalizations and health care costs
  • Worse health outcomes and increased mortality

Addressing the Challenge of Low Health Literacy

Strategies to improve the quality of care and outcomes for people with low health literacy involve educating clinicians and community members about health literacy, improving patient-provider communication, implementing evidence-based interventions in health care settings, and designing low-literacy health education, prescription information, and health services forms.

In 2007, the North Carolina Institute of Medicine Health Literacy Task Force made five specific recommendations to address the problem of health literacy:

  1. Identify evidence-based models, or best practices, of communicating health-related information and skills to people with low health literacy.
  2. Improve health literacy awareness, knowledge, and skills among health care professionals in clinical settings in order to improve patients understanding and help patients make appropriate health decisions.
  3. Improve health literacy awareness, knowledge and skills among literacy professionals in order to increase health literacy education in targeted literacy populations.
  4. Develop systems to improve health care communications to people with low health literacy skills in publicly-funded programs, including public health, mental health, mental health, Medicaid, and the aging.
  5. Identify strategies to more effectively communicate population-based health education messages to people with low health literacy.

The North Carolina Program on Health Literacy aims to help organizations and individuals work toward these recommendations to improve health literacy and the health of North Carolinians with literacy limitations.