1. Health Literacy: Tools You Can Use
Julie Gazmararian, PhD, MPH
Kara Jacobson, MPH, CHES
Department of Health Policy and Management
Rollins School of Public Health
Emory University

2. Overview Overview of health literacy Definition Prevalence Impact
Strategies for improved communication
Tools
Assessment
Open discussion

3. National Adult Literacy Survey (NALS)
“Using printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential” (National Literacy Act of 1991)
Prose, Document, Quantitative

4. NALS 2003 Results
National Adult Literacy Study, 2003

7. Health Literacy Healthy People 2010 AHRQ IOM
Objective 11-2: Improve health literacy
Objective 17-3: Increase review with older patients newly prescribed and OTC medications
AHRQ
Evidenced-based review of health literacy
IOM
Priority Areas for National Action: Self-management/Health literacy
Report from Committee on Health Literacy

8. What is Health Literacy?
In this report, the committee accepted the definition of health literacy presented by the National Library of Medicine:
The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
(Selden et al. 2000; Healthy People 2010, HHS 2000; Ratzan & Parker 2000)

9. What is Health Literacy?
Not only reading skill….BUT ALSO
Writing
Speaking
Listening
Numeracy
Cultural and Conceptual knowledge

10. "The health of our country depends on our understanding of basic health information in order to lead a healthy life"
U.S. Surgeon General Carmona

11. Low “health” literacy 1 out of 339
Low “health” literacy
Low literacy
1 out of 4
Increasing attention – take from Terry’s slide
Transition to NBC nightly news, aired, fall 2002
1 out of 3

12. Health Literacy Challenges
Most people cannot understand health information they need
It’s hard to be a patient these days and it’s easy to mess up
An issue of quality — essential for self-management, reducing disparities and reducing costs

15. Problems Associated with Low Health Literacy
Compliance with medication
Poor health status
Knowledge of basic self-care
Hospitalizations
Follow-up visits
Physician visits
Comprehension of informed consent, medical forms, insurance benefits
Costs

16. Health Outcomes Associated with Literacy
General health status
Hospitalization
Emergency department use
Prostate cancer stage
Depression
Diabetes control
HIV control
Mammography
Pap smear
Pneumococcal immunization
Influenza immunization
STD screening

17. Behavioral Outcomes Associated with Literacy
Substance abuse
Breastfeeding
Behavioral problems
Adherence to medication
Smoking

18. Knowledge-related Outcomes Associated with Literacy
Birth control knowledge
Cervical cancer screening
Emergency department instructions
Asthma knowledge
Hypertension knowledge

19. Does Inadequate Literacy Lead to Excess Medicare Hospital Costs?
36 Million Medicare Eligible
44% Functionally Illiterate
(16 million)
$ 2,262 per Person / Year
25% - 50% Higher Hospital Costs
Excess Hospital Costs = $8 - $15 BILLION

21. The main problem with communication is the assumption that it has occurred. George Bernard Shaw