How health care systems can begin to address the challenge of limited literacy

Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 09/2006; 21(8):884-7. DOI: 10.1111/j.1525-1497.2006.00544.x
Source: PubMed


Conclusion The growing literacy and health literature calls attention to the ways in which the U.S. health care system is inadequate
and even unjust, not only for the estimated 90 million U.S. adults with limited literacy, but for many other users to the
system. We have presented 3 overarching principles for health system transformation that focus on promoting productive interactions
between patients and providers, reorganizing health care delivery, and embracing a community level and ecological perspective.
We believe that instituting such changes could improve the quality of care not only for patients with limited literacy, but
for all health care consumers, and could contribute to the development of a more “health literate” society.

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Available from: Michael Paasche-Orlow
    • "Wolf, and Kirsh (2008) described this challenge as a " perfect storm, " with an aging population that has inadequate health literacy confronting an increasingly fragmented and consumer-driven health care system that puts a premium on patient autonomy. Many older adult patients who must manage chronic illness experience age-related declines in the health literacy–related abilities required for complex self-care tasks such as managing medication regimens or comprehending complex treatment information, but they do not receive adequate support from their health care system (e.g., Jansen et al., 2008; Paasche-Orlow, Schillinger, Greene, & Wagner, 2006; Wolf, Gazmararian, & Baker, 2005). "
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    ABSTRACT: Purpose of the Study: Health literacy is associated with health outcomes presumably because it influences the understanding of information needed for self-care. However, little is known about the language comprehension mechanisms that underpin health literacy. Design and Methods: We explored the relationship between a commonly used measure of health literacy (Short Test of Functional Health Literacy in Adults [STOFHLA]) and comprehension of health information among 145 older adults. Results: Results showed that performance on the STOFHLA was associated with recall of health information. Consistent with the Process-Knowledge Model of Health Literacy, mediation analysis showed that both processing capacity and knowledge mediated the association between health literacy and recall of health information. In addition, knowledge moderated the effects of processing capacity limits, such that processing capacity was less likely to be associated with recall for older adults with higher levels of knowledge. Implications: These findings suggest that knowledge contributes to health literacy and can compensate for deficits in processing capacity to support comprehension of health information among older adults. The implications of these findings for improving patient education materials for older adults with inadequate health literacy are discussed.
    No preview · Article · Jul 2015 · The Gerontologist
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    • "While research has focused on individuals, some researchers believed that HL reflects the contextual demand on health care [15]. The structural barriers for individuals with low HL include the complex tasks, the limited access to the health care, and the inadequate preparedness of health care providers [15]. Existing payment structures may encourage health providers in village clinics and township health centers to emphasize medical services over health education, making health education a mere formality. "
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    ABSTRACT: We examined the relationship between low health literacy (HL) and health-related quality of life (HRQoL) as well as relationship differentials by ethnicity among rural women from a Chinese poor minority area. We conducted in-person interviews with 913 rural women aged 23 -- 57 (57.5% Hui minorities/42.5% Han ethnicity) enrolled in the Ningxia Women Health Project, gathering data on EQ-5D, self-designed HL, socio-demographic characteristics, and chronic diseases. The extent of impairments in the five dimensions of the EQ-5D was used to measure HRQoL. Factor analysis yielded a single HL factor, which was used as a dichotomous variable in multivariate log-binomial regression models that examined the adjusted association of HL with HRQoL RESULTS: Nearly half of the women had no formal education. The most prevalent impairments were pain/discomfort and anxiety/depression (42.42% and 32.09%, respectively). The Hui minorities had 1.65 times higher rates of low HL (defined as less than mean of the factor score for HL) and 1.22 and 1.25 times for pain/discomfort and anxiety/depression impairments, respectively. Low HL was associated with poor HRQoL, with a 23% increase in the prevalence of pain/discomfort impairments after adjusting for socio-demographics. This association was significant in the Hui group (PR=1.30, 95% CI=1.06-1.58) but not for the Han group (PR=0.99, 95% CI=0.76-1.30). HL-stratified analysis revealed modification for ethnic disparities in HRQoL; for pain/discomfort impairments, high HL-PR=0.88 (95% CI=0.71-1.08), low HL-PR=1.24 (95% CI = 1.01-1.52); for anxiety/depression impairments, high HL-PR=0.98 (95% CI=0.73-1.32), low HL-PR=1.44 (95% CI = 1.05-1.98). Low HL is associated with poor HRQoL across the entire sample and the association may be modified by ethnicity. Similarly, ethnic disparities in HRQoL may be modified by HL, larger in low HL group. Health services should address HL in vulnerable minority women to improve their HRQoL.
    Full-text · Article · Sep 2013 · Health and Quality of Life Outcomes
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    • "It has also been argued that in places where there is growing racial, ethnic or linguistic diversity, a plan to increase the diversity of health care teams, is necessary (Paasche-Orlow et al., 2006). This approach has been advocated due to evidence that health literacy, which is lower in some racial and ethnic groups (Derose et al., 2007, Paasche-Orlow et al., 2006), is associated with higher distrust of health care providers as well as a lower desire to be involved in medical decisions (Paasche-Orlow and Wolf, 2007). In addition, there are also studies showing better health outcomes due to enhanced trust when there is racial concordance between health care providers and patients (Fiscella et al., 2000, Bao et al., 2007). "
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    ABSTRACT: Health is unevenly distributed across different social groups and the burden of chronic diseases falls disproportionately on people with lower socioeconomic status. Evidence-based health care services can mitigate the negative impact of chronic diseases at societal and individual level. However, the quality of care received by chronically-ill patients is also shaped by their socio-economic status with people from lower socio-economic groups receiving less preventive and curative care than their better-off counterparts. Several authors have argued that the social gradient in health is partly the result of a deficit in the quality of care. The Chronic Care Model (CCM) is an evidence-based policy response devoted to improving the quality of chronic care at the level of primary care. It has been implemented in several Western societies to decrease the morbidity and mortality associated with chronic diseases. The initial evaluations have shown that it is efficient and can also mitigate the social gradient in health. However, the pathways through which it acts on the social determinants of health have not been analysed in detail. In this paper we outline the materialist-structuralist and social capital pathways, described in the literature, through which social determinants shape the social gradient in health. We show that the CCM could mitigate the social inequalities in health by increasing the level of social capital at the level of health care systems. However, it does not act on the materialist and structural causes of the health inequalities and this may raise a significant concern that in the absence of other social policies it may actually increase the social inequalities in health.
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