Addressing patient health literacy

Physicians can create a treatment plan, but if patients do not understand the what, why and how, they may not be able to adhere, says Natalia Southerland, MD, a family medicine specialist in Waxahachie, Texas. Southerland, who is also a certified personal trainer and health coach, strives to ensure patients are health literate, meaning they can find, understand and use information to make appropriate health decisions.

Addressing health literacy does not necessarily require much of Southerland’s time or effort. For example, she frequently gives patients educational materials and handouts, explaining the information as succinctly as possible. This includes handouts she has created as well as those from organizations like the National Lipid Association.

“I consider myself an educator,” she says. “If I provide information, teach patients how to find credible information and make sure they understand and know how to use that information, they will become independent health care consumers who can take control of their own health.”

Health literacy is also associated with significant cost savings. Improving health literacy for Medicare beneficiaries alone could prevent nearly 1 million hospital visits and save the health care system more than $25 billion annually, according to recent data published by UnitedHealth Group (UHG).

That is because patients who follow treatment plans, take medications correctly, complete needed screenings and receive recommended care are more likely to achieve their best health, says Anne Docimo, MD, chief medical officer at UnitedHealthcare, where she is responsible for the clinical, cost and experience outcomes of more than 50 million members in the company’s commercial, Medicare and Medicaid health plans.

“The extent of limited health literacy is not generally recognized,” says Cindy Brach, M.P.P., senior health care researcher at the Agency for Healthcare Research and Quality’s (AHRQ) Center for Evidence and Practice Improvement and co-chair of the U.S. Department of Health & Human Services Health Literacy Workgroup. “Limited personal health literacy, which affects more than a third of adults in the United States, is associated with lower receipt of preventive services, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret health messages, greater hospital and emergency care use and, among seniors, poorer overall health status and higher mortality.”

What is important for physicians to remember, Docimo says, is that health literacy is not only about a static population, such as individuals for whom English is a second language. Someone with relatively high health literacy could face challenges when trying to understand a new diagnosis, she adds.

It is also important for physicians to realize that unlike other social determinants of health such as food or housing insecurity — solutions that require significant investment and partnership with other organizations — they and their staff can improve health literacy using simple strategies, says Brach.

Telehealth and health literacy

Experts agree that telehealth presents opportunities to improve health literacy. “The access alone can improve it because you don’t have barriers related to transportation and physically getting from your home to the doctor’s office,” says Docimo. Physicians can also use visual aids just as they would in person, she adds.

“In this day and age when everyone wears a mask, it’s almost easier to do a telemedicine appointment because you can see the patient’s facial expression,” says Hydok. “Sometimes you even get a glimpse of the patient’s home — and that can give you more information.” For example, a physician can ask patients to show where they keep their medication. If they see unrefrigerated insulin on the counter next to various pill bottles, they know there has been a communication breakdown.

Health literacy and COVID-19

Populations struggling with health literacy before COVID-19 will struggle during the pandemic, says Southerland, who tries to stave off misinformation by providing patients with links to credible websites such as the Centers for Disease Control and Prevention. She also curates some of that information herself so patients do not become overwhelmed by the volume of content available. For example, she compiles answers to questions her patients ask most frequently (such as “If I’m exposed, do I need to get a test?” or “When can I go back to work after testing positive?”) and then sends mass communications through the portal to educate patients.

“There’s going to be a need for coordinating care, educating patients and staying on it to make sure they complete the series of two vaccines — the initial one and the booster,” says Docimo.

This is especially true for patients with low health literacy who are part of diverse communities, says Ronick. “Many populations in the U.S. today speak different languages at home and have different cultural practices than the dominant White culture,” she says. “As we look at administering the COVID-19 vaccine, we won’t be successful unless we address potential cultural barriers.”