Breakthrough Patient Recruitment

: How Poor Health Literacy Affects the Ability to Understand and to be Understood

How Poor Health Literacy Affects the Ability to Understand and to be Understood

Managing Editor

It's no secret that there are problems in the U.S. health care system. Costs are high. Rates of chronic diseases are high. There's a provider shortage. The immigrant and minority population is rapidly increasing, as care disparities continue to prevail. But the biggest problem is our inability to communicate within the health care system.


Speaking at the Center for Health Literacy's conference, Plain Talk in Complex Times, Chris Gibbons, the associate director of the Johns Hopkins Urban Health Institute discussed what he calls a coming health care communications crisis. I think he's on to something.


What's Driving the Communications Problem?


A full 40 percent of Americans-115 million people-cannot understand health information. Poor health literacy impacts the health care system in myriad ways-but at the top of the list is patient trust, engagement, satisfaction, and adherence. If patients don't understand what we're saying, they are much less likely to trust us and to do what they need to do to comply with their health care regimen.


And it's not that people are uneducated or illiterate. It's that we've not done a very good job of explaining critical health care information to them, and that can be dangerous. Check out this video from the American Medical Association to see real people talk about health literacy.


 AMA Health Literacy Video


With the Affordable Care Act set to introduce 30 million more people into the health care system in 2014, we've got a serious issue on the horizon with a short timeframe to fix it. According to Gibbons, the annual cost of low health literacy is between $106 billion and $238 billion. Meanwhile, a the report, Low Health Literacy: Implications for National Health Policy, people with low health literacy more often use emergency services, are less likely to properly control chronic disease, and use preventative services and treatments, such as childhood immunizations and mammograms less often. In turn, this impacts readmissions and reimbursements, waiting times, and downstream, health disparities. Individuals with low health literacy have increased use of emergency services, are less likely to be able to control chronic diseases such as diabetes, and have lower use of preventive procedures, such as early childhood immunizations and mammograms.


Moreover, in 2007, 55 million people (20 percent of the U.S. population) spoke a language other than English at home. What are they speaking? 62 percent are speaking Spanish, Spanish Creole, and Ladino. Indo-European languages, including most languages of Europe and languages of India are spoken in 19 percent of homes in the United States. Asian and Pacific languages are spoken by 15 percent of the populations. And all other languages account for the other 4 percent.  


What's more, 50 percent of people who don't speak English at home said they did not speak English very well. This number is even higher among older people. For instance, 65 percent of Spanish speakers older than 65 reported that they were unable to speak-or understand-English very well.


Bottom line:  The number of people with poor English fluency is increasing, and it's not just happening in states with large immigrant populations, such as New York, Texas, Florida, and California.  It's happening in your city, in your state, and in your facility. For more on language barriers and their effects on patient care, check out this post from, Gretel Galo, a materials coordinator at MMG.


So what can we do?


Right now, we still have a one-time, paper-based, word-dense style of communicating. But Gibbons says the future is in technology. Information that is available electronically, that you can take anywhere, and that can be accessed by any device is the way of the future. Video- and graphic-based information that is culturally appropriate is also key.


Here are some tips for helping readers understand health information courtesy of McGee & Evers Consulting's Quick Checklist for Plain Language:


  • Write in an active voice
  • Use words that are common and familiar to the intended reader
  • Use acronyms, abbreviations, technical terms, and legal terms only in the readerneedsto know them, and they should be explained if they are used
  • Paragraphs should be on one topic and should be brief, with simple and straightforward sentences
  • Terms should be used consistently
  • Instructions should be brief, step by step, and placed where the reader needs them
  • The writing should be cohesive, making connections among ideas to help readers understand and absorb new information



0 :


The Healthy(ist) blog is a platform to share, learn about, and debate topics related to public and social health, scientific research, health communications, and behavior change.
We invite and encourage anyone interested in current public health and health communication trends and issues to join MMG's contributing bloggers in adding their voice to the ongoing discussion about how we can advance health, together.


MMG Headquarters
700 King Farm Boulevard
Suite 500
Rockville, MD 20850
+1-301-921-4405 (fax)
MMG Europe
Thremhall Park
Start Hill
Bishops Stortford
Hertfordshire CM22 7WE
+44(0) 1279 874463