1. Newland, Jamesetta RN, PhD, FNP-BC, FAANP, FNAP

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One out of every seven Americans, or approximately 32 million people, has some degree of difficulty reading anything above the level of a children's picture book or understanding adverse reactions listed on a medication bottle.1

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A recent USA Today report discussed data found in two national (representative) surveys conducted in 1992 and 2003. Basic Prose Literacy Skills (BPLS) were measured in three domains-prose, document, and quantitative literacy at four performance levels-below basic, basic, intermediate, and proficient. Results of the direct estimates showed lacking BPLS in 14.5% of the population in 2003 and 14.7% in 1992; and a below basic proficiency in prose literacy of 13.6% in 2003 and 13.8% in 1992.2 Details and study limitations are noted in the full report.


Patient literacy

Using medical terminology to communicate, whether oral or written, complicates language and can often cloud comprehension for many patients. Only informed patients can participate fully in the management of their care.


Objective 11 in Healthy People 2010 addresses health information. 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."3 Numerous demographic variables such as age, ethnicity, education, and income were factored into the equation. APNs also consistently assess different patient characteristics to determine language capabilities as well as limitations.


Limited health literacy is more prevalent among older adults, minority populations, the poor, and the medically underserved-populations that traditionally seek healthcare from APNs. Remember, though, that individuals with excellent general literacy skills who do not fit into any identified vulnerable category are also at risk for low health literacy because of the specialized nature of medical information.


Helping patients understand

Health literacy has become a key factor in preventing medication errors, especially errors that involve self-administered medication. Patients should be counseled about benefits, risks, proper use, and adverse reactions every time a medication is prescribed, reviewed, or renewed.


Patients often leave the office or pharmacy with written materials meant to reinforce information given verbally. Authors Shrank and Avorn4 advocate for stricter regulations of consumer medication information (CMI) by the FDA. CMI is found on container labels, leaflets, package inserts, medication guides, and on the Internet. Although black box warnings are prominent on labeling, other information may be written in a font too small for the elderly or visually impaired to read, or written at a higher grade level that challenges someone with poor health literacy. There currently is no standardization for CMI presentation.


Healthy People 2010 offers suggestions to help improve patient understanding: identify patients with limited literacy levels; use simple language, short sentences, and define technical terms; organize information so that the most important points stand out and repeat this information; supplement instruction with videos, models, pictures, and other aides; ask patients to repeat instructions; provide information in the patient's primary language; use universal symbols when possible; and offer to help patients complete forms.5


Jamesetta Newland, RN, PhD, FNP-BC, FAANP, FNAP

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1. Toppo G. Literacy study: 1 in 7 U. S. adults are unable to read this story. USA Today. January 9, 2009. [Context Link]


2. Mohadjer L, Kalton G, Krenzke T, et al. National Assessment of Adult Literacy: Indirect County and State Estimates of the Percentage of Adults at the Lowest Level of Literacy for 1992 and 2003 (NCES 2009-482). National Center for Education Statistics, Institute of Education Sciences. U.S. Department of Education, Washington, D.C.; 2009. [Context Link]


3. Healthy People 2010. Office of Disease Prevention and Health Promotion. 11 Health Communication. [Context Link]


4. Shrank WH, Avorn J. Educating patients about their medications: the potential and limitations of written drug information. Health Aff. 2007;26: 731-740. [Context Link]


5. HRSA. Health Literacy. [Context Link]