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New Evidence Report Illustrates Links Between Health Literacy and Health Care Use and Outcomes

Press Release Date: April 8, 2004

The nation's estimated 90 million adults with lower-than-average reading skills are less likely than other Americans to get potentially life-saving screening tests such as mammograms and Pap smears, to get flu and pneumonia vaccines, and to take their children for well child care visits, according to a new evidence report released today by Carolyn M. Clancy, M.D., Director of the Agency for Healthcare Research and Quality. AHRQ commissioned the evidence review at the request of the American Medical Association.

People with a low level of literacy have difficulty reading newspapers and other simple information such as directions for taking medications or hospital discharge instructions. They are also more likely to be hospitalized, which may be because physicians are concerned about the patients' abilities to follow basic instructions and care for themselves at home when they are sick.

"Health literacy is the currency of success for everything that we do in primary and preventive medicine," said Surgeon General Richard H. Carmona, M.D., M.P.H., F.A.C.S. "Health literacy can save lives, save money, and improve the health and well-being of millions of Americans. All of us—government, academia, health care professionals, corporations, communities, and consumers—working together can bridge the gap between what health professionals know and what patients understand, and thereby improve the health of all Americans."

Low literacy plays an important role in health disparities and may contribute to lower quality care and even medical errors, noted Dr. Clancy. "This research review confirms the negative impact of low literacy on health outcomes, but even more importantly, it provides a roadmap for the research that needs to be done to answer key questions, including which are the most effective ways to improve health literacy."

Last year, AHRQ, the AMA, and the American Hospital Association launched a campaign to help educate clinicians and patients about the importance of effective communication. As part of the 5 Steps to Safer Health Care campaign, posters with five simple tips to encourage dialogue between patients and providers were distributed to doctors' offices and hospitals nationwide.

"For the 90 million Americans with limited literacy skills, it's tough to read the front page of a newspaper or a bus schedule, much less the complicated documents that go along with being a patient in our country today," said John C. Nelson, M.D., AMA President-Elect. "Since 1998, the AMA has been tackling the problem of health literacy because we believe that quality health care depends on patients who are active participants in their own care, and low health literacy robs them of that opportunity."

The AHRQ-supported evidence review also found that people with lower literacy skills are more likely to have difficulty understanding informed consent forms and in comprehending their children's diagnoses and medication instructions. They are also less likely to be knowledgeable about the health effects of smoking, diabetes, asthma, AIDS, and post-operative care. In addition, the review found evidence suggesting that well-conceived interventions such as easy-to-read guides and other comprehension aids can at least improve the outcome of knowledge for both lower- and higher-literacy patients.

Dr. Clancy noted that AHRQ has developed several low-literacy publications aimed at helping people avoid medical errors, take medications safely, and obtain appropriate preventive services. These publications can be found on AHRQ's Web site at www.ahrq.gov/consumer/pathqpack.htm.

In addition, the AMA and the AMA Foundation have developed a health literacy kit for physicians and other health professionals called "Health Literacy: Help Your Patients Understand," which contains a 48-page manual for health professionals, a video, patient information, and buttons for physicians and their office staff to wear that say simply: "Ask me—I can help." The AMA kit is available on line at www.amafoundation.org.

The AHRQ report calls for more health literacy research to examine whether poor reading ability is really the cause of adverse health outcomes or whether it is a marker for other problems, such as low socioeconomic status, impaired access to care, and low trust in medical providers. It recommends that a patient-centered research design would help identify the challenges associated with navigating the health care system.

The Department of Health and Human Services is addressing health literacy in many ways through its Healthy People 2010 initiative. For example, HHS worked with the Department of Education to develop the first-ever national assessment of health literacy, called the Health Literacy Component of the National Assessment of Adult Literacy. The first data from the new survey will be available in late 2004.

A summary of Literacy and Health Outcomes, which was prepared by AHRQ's Evidence-based Practice Center at RTI International-University of North Carolina at Chapel Hill, is available online at www.ahrq.gov/clinic/epcsums/litsum.htm. The full report is can be downloaded as a zipped file from www.ahrq.gov/clinic/evrptfiles.htm#literacy. Printed copies of both documents are available by calling AHRQ's Publications Clearinghouse at 1-800-358-9295 or by E-mailing ahrqpubs@ahrq.gov.

For more information, please contact AHRQ Public Affairs: (301) 427-1539 or (301) 427-1855.

Internet Citation:

New Evidence Report Illustrates Links Between Health Literacy and Health Care Use and Outcomes. Press Release, April 8, 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2004/litpr.htm

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