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Assistive Technology Resources National AgrAbility Workshop (2001 - 2008)
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Promoting Success in Agriculture for People with Disabilities and Their Families
Focus – Health LiteracyHealth Literacy: A critical but hidden health issueHealth literacy is one of the most widespread obstacles to achieving better health outcomes in the United States. Since clear communication is a critical element to a successful health care system, understanding the impact of health literacy is paramount. The Partnership for Clear Health Communication (PCHC) defines health literacy as the ability to read, understand, and act on health information. 1 The Institute of Medicine (IOM) further defines it as the degree individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions. 2, 5 Health literacy is more than just reading. Health literacy refers to a variety of skills including reading, writing, numeracy, listening, and speaking. 1 The ability of the consumer to articulate health concerns, describe their health condition accurately, ask pertinent questions, and understand spoken advice and treatment directions, in addition to locating and evaluating health information is critical to making informed health decisions. According to D. Nutbeam in Literacies across the lifespan: Health literacy 4, health literacy can be broken into three ability levels:
Health literacy is not just the responsibility of the consumer. Health literacy also hinges on the skills, preferences, and expectations of those that provide health information, such as health care professionals, the media, and at times, AgrAbility staff. Scope of the problemLow health literacy can affect anyone, regardless of age, race, education, or income, and it cannot be recognized by physical symptoms or upon examinations. Americans are more educated today than during any other time in history. The average educational level achieved by American adults is the 12 th grade, but average reading skills are between the 8 th and 9 th grade level. 3 Likewise, rural Americans are more educated than ever before – today 40% have education beyond a high school diploma. 10 Though more educated, rural Americans are still lagging behind those living in metro areas where 55% have education beyond the high school level. 10 Hired farmworkers are the least educated of all Americans in the workforce with 52% of them having less than twelve years of formal education and 31% having less than nine years of education. 11 According to IOM, ninety million people – more than half of all American adults – have difficulty understanding health information, because most medical information is written on a 10 th grade or higher reading level. 3 This would seem to imply that most Americans, with an average reading skill between the 8 th and 9 th grade, may lack the basic literacy skills required to effectively navigate and use the U.S. health care system. The problem may be growing because consumers are expected to be more informed and involved in their own personal health care, while at the same time, the health care system is becoming increasingly more complex and difficult to understand.
Impact of health careA deficit in health literacy leads to an incomplete understanding of health problems and/or treatments. 6 Seventy-five percent of consumers in the U.S. with chronic health problems, such as hypertension, diabetes, and respiratory problems, are in the limited literacy category. 6 Low literacy is related to higher instances of hospitalizations, use of emergency services, more medication and treatment errors, and noncompliance with treatments. 6 In 2000, the Center for Health Care Strategies reported that the effects of low literacy cost the U.S. up to $73 billion each year. 9 Unfortunately, many health care providers, the public, policymakers, and others remain unaware to the extent of the problem. Compounding the issue is the fact that most patients hide their lack of health literacy and confusion from health care providers because they are too ashamed or intimidated to ask for help. Populations at-risk for low health literacyPopulations most at-risk for low health literacy include poor, less educated, older, those with disabilities or chronic health conditions, and minorities. The largest proportion of American adults with limited literacy is native-born Caucasian speakers of English. 3 Rural Americans are one of the most at-risk populations for low health literacy because of the higher incidence of poverty and lower educational levels as compared to metro areas. Despite farm poverty being the lowest in history, rural areas still have higher instances of poverty than metro areas. 10 Living in poverty tends to lead to higher instances of low health literacy. 3 According to the National Adult Literacy Survey, people with disabilities/chronic health conditions are another large at-risk population for low health literacy. As an example, more than half of the individuals with hearing, speech, and visual disabilities scored low in literacy. 3 This may compound health issues because people with disabilities or chronic health conditions tend to interact frequently with the health care system. Health literacy may define their quality of life and ability to make sound health care decisions. Additionally, more than two-thirds of Americans, age sixty and over, have either inadequate or marginal literacy skills. 3 Research suggests that 40% of senior citizens cannot read the simplest brochure and at least 70% of older Americans living in rural areas have twelve years of education or less. 3, 10 A disproportionate number of minorities and immigrants are estimated to have health literacy difficulties because of language and/or cultural differences. In 1993, Kirsh et. al. reported results from the National Adult Literacy Survey indicating that over 50% of Hispanics, nearly 40% of African Americans, and 26% of Native Americans/Alaska Natives have low literacy. 3 Recognizing the crisisHealth literacy is a “hidden crisis” arising from educational, social, and cultural factors. The problem is often hidden because people feel ashamed or overestimate their skills. A person may be articulate and have attained higher levels of education yet possess low literacy skills. Some common signs of low health literacy include:
Health literacy is a growing concern in health care, especially for those at-risk populations. Several public and non-profit health care organizations are hard at work creating resources to improve health literacy and promote a greater awareness of the issue. The IOM calls for a concerted effort by the public health and health care systems, the education system, the media, and health care consumers to improve the nation’s health literacy. Additional Health Literacy Resources
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