and How it Affects Quality Care
is the first step toward providing quality care for patients. The
next step involves patient comprehension of and compliance with
recommendations. According to the American Medical Association’s
Ad Hoc Committee on Health Literacy for the Council of Scientific
Affairs, your best efforts to obtain comprehension and compliance
can be ineffective due to the low functional literacy of your patients.
If the patient does not understand treatment, quality of care is
compromised and the patient is likely to experience poor health
the United States has a large, highly educated population, there
is also a large segment of the population with limited skills. In
1993, the United States Department of Education (USDOE) conducted
a survey of 26,000 individuals, a representative sample of adults
in the United States, to profile English literacy. Users were tested
in three areas and results placed them into one of five categories.
The areas tested were prose (the ability to read and comprehend),
document (the ability to read maps and follow directions), and quantitative
(the ability to perform basic math computations). The study concluded
22% could perform only simple, routine tasks involving brief and
uncomplicated texts. Moreover, the English Language Proficiency
Survey (ELPS) of 1992 estimated 90 million, about half of the U.S.
population, could perform tasks at Level 2. This means they could
locate information in text, make low-level inferences using printed
materials, and integrate easily identifiable pieces of information.
When patients for whom English is a second language and those with
hearing and/or visual problems are added to the group, physician-patient
communications become far more difficult and complex.
research reports the benefits of effective patient education as
presented in recent articles...
is a pervasive problem that this recent study found compromises
quality healthcare, limits understanding of health information
and potentially leads to poor health outcomes. A positive statistical
relationship was found between educational material readability,
client literacy, and client-perceived benefit and quality of care.
randomized controlled trial conducted at the Grady Memorial Hospital
in Atlanta, GA, tested use of a low literacy education tool with
at-risk populations to determine if the tool would increase pneumococcal
vaccination rates. Those patients receiving the education material
were four times more likely to discuss the issue with their physician
and five times more likely to get vaccinated.
of documented patient or family education was found to be a factor
in unplanned hospital readmissions among patients 65 years of
age and older in a managed care plan. Unplanned hospital readmission
within 30 days of discharge is considered a "sentinel event"
for poor quality.
degenerative diseases all have one thing in common-the prolonged
course of the disease. Patient education is key to helping client
feel in control of the development of the disease. Through education,
the patient can become his/her own advocate and an active participant
in the doctor-patient relationship. This participation increases
patient compliance for short- and long-term disease management.
articles alone indicate patient education can increase immunization
rates, decrease hospital readmissions, and empower patients to make
better decisions about lifestyle and care. Ultimately, patients
feel they receive better quality treatment when patient education
is part of their care.
Joint Commission on the Accreditation of Health Care Organizations
(JCAHCO) requires that hospitals have a patient education program
in place to be accredited. Although there is no literacy level recommended
in the body of JCAHO’s handbook, The Comprehensive Accreditation
Manual for Hospitals (CAMH): The Official Handbook states the
basic requirement is hospitals should provide patient education
that meets the literacy level of their patient population. This
means education materials must meet the needs of the population’s
low literacy segment. Education materials written at a lower literacy
level are likely to be effective for a broader range of patients.
The Keystone Center has introduced the "Action Plan for the
Provision of Useful Prescription Medicine Information" that
recommends a 6th to 8th grade reading level
for medication materials distributed to patients.
added dimension to the discussion is that literacy is hard to measure.
Literacy at one time meant reading level. Now some tests attempt
to measure recognition and comprehension. As the meaning of "literacy"
has evolved, so has its description. The result is a wide a variety
of "literacy" tests and just as wide variety in the results
of these tests given the same document. In addition, these literacy
tests do not and cannot take into account graphic elements meant
to enhance comprehension. Because of differing meanings, inadequacy
of tools to measure graphic enhancements, and lack of standardized
tests and/or benchmarks for testing, publicized document literacy
levels should be reviewed judiciously and used cautiously.
a concerted effort to make the patient education documents in the
Micromedex® CareNotes System as accessible
to patients as possible, without compromising content, our editorial
team has developed a style sheet. All CareNotes clinical editors
use this sheet when writing patient education leaflets. The style
sheet has been compiled by reviewing the variety of literacy tests
currently available. Among these were SMOG, FOG, Flesch Reading
Ease, Flesch-Kincaid Grade Level, Coleman-Liau Grade Level, and
Bormuth Grade Level. Utilizing the common features of the "literacy"
tests, the style sheet has proven an effective foundation for creating
documents that consistently test out at the 6th to 8th
grade reading level. When medical terminology is removed from CareNotes
documents, they test at even lower literacy levels. Micromedex believes
the medical terminology should be included because these terms are
central to the patient understanding the care being received. Instead
of excluding these terms, phonetic pronunciation is given and the
terms are described in low literacy language.
encourages you to empower your patients with health information
so they make the best health choices possible. For more information
on how Micromedex can help in this effort, call (800) 525-9083.
following bibliography lists articles on literacy and its effects
on healthcare outcomes:
Hoc Committee on Health Literacy for the Council on Scientific Affairs,
American Medical Association. Health literacy: report of the Council
on Scientific Affairs. The Journal of the American Medical Association
DW. "Reading between the lines: deciphering connections between
literacy and health." Journal of General Internal Medicine, May
Diana S. et al. "Patient information systems that tailor to the
individual." Patient Education and Counseling, 36 (1999)
Evelyn. "Low literacy levels in adults: implications for patient
education." The Journal of Continuing Education in Nursing, March/April
KS et al. "Relationships among educational material readability,
client literacy, perceived beneficence, and perceived quality."
Journal of Nursing Care Quality, August 1999.
Terry A. et al. "Use of a low-literacy patient education tool to
enhance pneumococcal vaccination rates: a randomized controlled
trial." The Journal of the American Medical Association, August
Edward R. et al. "Factors associated with unplanned hospital readmission
among patients 65 years of age and older in a Medicare managed care
plan." The American Journal of Medicine, July 1999.
Assessment of Adult Literacy. http://nces.ed.gov/naal/
States Department of Education. Adult Literacy in America: National
Adult Literacy Survey. Washing, D.C. 1993
Eijk, J. Th. M. et al. "Care for the chronically ill: the future
role of health care professionals and their patients." Patient Education
and Counseling, 35 (1998)
Terrence G. "Estimating literacy in the multilingual United States:
issues and concerns" ERIC Digest: National Clearinghouse for ESL
Literacy Education, September 1994.
Feleta L. "Are Patient Information Materials Too Difficult to read?"
Home Healthcare Nurse, vol. 18 no. 2/February 2000.