Blog: Dealing with patients with low health literacy in primary care

“…I never ask questions much about it because there’s damn all I can do about it really…there’s no point in me asking when I don’t…understand it…” (a patient with chronic diseases)

People with low level of health literacy have difficulties in understanding health-related messages, discussing their needs and demands with the healthcare professionals and making informed decisions regarding staying healthy, managing existing health conditions and related treatments. One health practitioner mentioned: “I have a lot of patients come in and say I’ve got this pillbox and I don’t know what I’m taking.”

That is not always easy to tailor communication to the needs of patients or their significant others is illustrated by a comment of one of the General Practitioners (GPs): “I had a little lady who nearly starved once. Her elderly brother used to look after her and it wasn’t [until] he died, that I realised that she couldn’t read. And she couldn’t shop, do you know what I mean? You forget you’ve made assumptions about people’s literacy levels all the time” (a General Practitioner).

The impact of low health literacy on health is high. It can lead to limited access to prevention, higher risk of chronic diseases, higher use of emergency services, higher rate of hospitalization, and higher mortality. Improving patient’s health literacy will enhance self-management of chronic conditions, increasing adherence to medical treatments, equity in access to health services and contribution to healthy life expectancy. – “It’s the ability to explain in simple terms and not be abstruse. To say look, on the list here it says you’re to have 15 g of carbohydrates. Now that’s a slice of bread or that’s a medium sized potato.” (a woman in her seventies with Diabetes).

Low literacy levels affect the accessibility of the hospitals. People that do not have an adequate health literacy level are not capable of fully understanding the messages transmitted by their GPs and, in the same time, they do not know what to ask or how to ask – “No. I did not know how to ask. Sometimes when I’m asked if I have any questions, I do not know what questions I’m supposed to ask” (a diverse underserved patient with cancer risk). They sign forms without reading or/ and understanding, agreeing therefore to procedures or treatments that they later will not accept: “I have signed a lot of papers without reading. I figure they ain’t gonna give me nothing to sign if it’s bad” (a rural patient with cancer). In the same time, because of this, they do not know where to go for their medical condition, putting a burden on the system and creating unnecessary costs: ‘‘I don’t know how to actually access a lot of the different things at this stage. Yeah. I find it very difficult to find out about things that would help. . . and that are appropriate to me. . . there doesn’t appear to be much. . .’’ (a patient with chronic conditions).

Development of competencies in health literacy communication will result in a more efficient utilization of health services and in work satisfaction of healthcare professionals, fostering effectiveness and sustainability of health systems. IMPACCT partners are working to provide their contribution to this challenge.

What do you know about health literacy? Let us know!