The Nurse’s Guide to Health Literacy
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Credit: SolStock | E+ | Getty ImagesAccording to one study, a majority of Americans (88%) have health literacy limitations. This can increase their risk for poor health. From failing to understand medication instructions to not sticking to vaccination schedules, low health literacy is a factor in increased healthcare costs and poor outcomes, especially in traditionally underserved communities.
Nurses can play a crucial role in improving health literacy. They are well-positioned to drive culture change and make healthcare more accessible and effective for all. Discover how nurses can carry out key strategies and support large-scale initiatives aimed at more equitable care.
What Is Health Literacy?
The federal government updated the definition of health literacy in 2020 to include two types: personal and organizational.
Personal health literacy is an individual’s ability to find, understand, and use health information to make health decisions. A person can choose behaviors for themselves and others in their care. For example, health literacy might refer to a parent’s or guardian’s ability to find information about childhood illnesses and use it to determine when to provide care at home and when to visit the pediatrician.
Organizational health literacy refers to how well an organization — which could be a physician’s practice, hospital, community clinic, insurance provider, or any other organization that provides health-related service — makes information available for individuals to use when making health-related decisions. This includes making information easy to find, understand, and equitable. For instance, this includes designing brochures, signage, and marketing materials with accessibility for persons with disabilities in mind.
Health equity is at the heart of health literacy initiatives. According to the Centers for Disease Control and Prevention (CDC), health equity means that everyone has the opportunity to reach their full health potential without disadvantages created by social circumstances. Achieving health equity requires awareness of an individual’s culture and how it affects their ideas and perceptions of health. It also affects how they communicate.
This doesn’t always mean finding ways to communicate with individuals who speak languages other than English, which is a priority in many communities. Some English-speaking patients may also have limited language proficiency and understanding. They require providers to use plain language free of medical jargon when explaining health concepts, treatments, and medications.
Health literacy is important. Patients with lower literacy levels are at increased risk for health problems and poor outcomes. This includes taking the wrong medication or taking medication incorrectly, failing to seek treatment, waiting too long to seek treatment, and needing more treatment as compared to those with strong health literacy.
Health Literacy Models
Health literacy is not a new concept. It first gained prominence in the 1970s. Since then, several models have emerged.
One of the most frequently used models is the Health Literate Care Model, which adds health literacy concepts to the widely adopted Care Model. This model aims to improve patient outcomes by empowering them to be more engaged in their care, including disease prevention, personal health management, and decision-making.
To accomplish this goal, the Health Literate Care Model is based on the concept of universal precautions. Rather than preventing the spread of pathogens, though, health literacy universal precautions call on nurses to approach every patient with the assumption that they are at risk of not understanding their health condition and how to manage it.
Their priority is to confirm and support better understanding. The model calls for this approach to become a foundational aspect of the organization, influencing planning and operations, care delivery, clinical information systems, and patient support services.
Health literacy extends beyond the patient’s bedside. The Health Literate Care Model also recognizes the need for community partnerships. Community partners, including emergency personnel, public health agencies, social services agencies, and literacy groups, help ensure access to health services and the resources individuals need to take care of themselves. They can also be vital resources for identifying the needs of the communities they serve and educating providers on how to improve health literacy.
The Health Literate Care Model supports interactions between providers and patients to improve health outcomes. A prepared and proactive team of healthcare providers, including nurses, can support informed, knowledgeable patients who are engaged in their care.
Health Literate Systems
Health literacy is a critical aspect of a functioning and effective healthcare delivery system. Even educated individuals can encounter challenges when managing their health. This includes understanding the implications of an illness, treatment options, and managing the complexities of self-care.
A good example is an individual newly diagnosed with diabetes. Managing this illness typically requires combining diet changes, regular blood tests, and medication. This can be overwhelming and confusing without education and support.
Expecting patients to navigate complex health information and systems (that sometimes provide conflicting information) contributes to low health literacy.
A health literate model of care supports health literacy and allows patients to better navigate, understand, and use health information through several strategies. These include:
1. Delivery system design
A well-designed healthcare delivery system gives providers the tools they need to efficiently determine the care that patients need. It clarifies the roles and tasks of everyone involved in providing care.
When everyone is on the same page, staff can adapt care to the individual patient’s level of health literacy. Patients receive consistent care and have the chance to seek clarification and ask questions.
2. Health information systems
Clinical information systems and electronic medical records are useful tools that allow providers and patients to stay on top of their health and manage care. Within the Health Literate Care Model, patient-facing systems are intuitive and user-friendly. They provide opportunities for education and tools for self-management, like reminders and opportunities for follow-up.
3. Self-management support
The majority of healthcare takes place outside of the doctor’s office. Patients need support and guidance in managing their health. Health literacy offers plenty of opportunities for questions and clarification, personal action plans, and using the “teach-back method.”
4. Shared decision-making
Health literate care involves patients in decisions about their healthcare. It makes care a collaborative effort between providers and patients, combining best practices and sound science with patient preferences.
In a health-literate organization, these strategies guide all aspects of the operation and are modeled by the entire organizational team.
Challenges and Opportunities
Because of their direct and indirect influence on healthcare delivery, nurses play a critical role in improving health literacy. Nurses are often the first point of contact for patients. They are also leaders in both organizational and public health change efforts.
However, despite evidence highlighting the consequences of low health literacy, it is not yet imperative in the practice of nursing. This creates both challenges and opportunities for nurses at all levels. The American Academy of Nursing (AAN) has called for several actions including:
Practice improvements.
A study of oncology nurses found that nurses face challenges assessing a patient’s health literacy and communicating with patients with low health literacy. Interestingly, more experienced nurses report having more challenges in this area than newer nurses.
However, nurses need education and training in how to assess health literacy. They must also learn communication strategies for patients with lower literacy. The AAN calls for nurses to use the universal precautions approach to create shame-free environments to support health literacy, speak in plain language, and include patient-specific health literacy diagnoses and interventions in patient records.
Policies and partnerships.
The AAN calls upon nurses to advocate for policy-level changes that integrate health literacy initiatives into efforts to improve patient safety and care quality. More specifically, nurses can advocate for funding and support for programs designed to improve health literacy education, system design, and nursing practice.
Another area where nurses can help improve health literacy is in the development of patient materials. In many healthcare organizations, nurses have direct involvement in creating patient education materials thanks to their role as educators. Nurses can ensure that patient materials are drafted using plain language and prioritize patient comprehension.
Nurses can also learn common signs of low health literacy, which might be subtle. For example, patients might be unable to explain why they take a certain medication, ask for help reading instructions, or state that they will review instructions at home. Sometimes, low health literacy can look like nonadherence — for example, patients might miss appointments or fail to follow-up with lab tests. But it may be that they simply do not understand the instructions.
Nurses need to be aware that patients may not understand the information that’s being shared with them. By taking steps to improve comprehension, both at the bedside and on a larger systematic level, nurses can improve patient outcomes and the overall well-being of the patients they serve.
Sources
- All practice tools. (n.d.). https://www.ahrq.gov/chain/practice-tools
- Health equity. (2022). https://www.cdc.gov/chronicdisease/healthequity/index.htm
- Health literacy basics (2022). https://www.cdc.gov/healthliteracy/basics.html
- Health literacy in the United States: Enhancing assessments and reducing disparities. https://milkeninstitute.org/report/health-literacy-us-assessments-disparities
- Health literacy in healthy people 2030. (n.d.). https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030
- Health literacy universal precautions toolkit, 2nd edition. (n.d.). https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html
- Health literate care model. (2021). https://health.gov/our-work/national-health-initiatives/health-literacy/health-literate-care-model
- Koh H., et al. (2013). A proposed ‘health literate care model’ would constitute a systems approach to improving patients’ engagement in care
- https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1205?siteid=healthaff&keytype=ref&ijkey=qIr%2FpMsfcfBKM&
- Loan L., et al. (2018). Call for action: Nurses must play a critical role to enhance literacy. https://www.nursingoutlook.org/article/S0029-6554(17)30628-0/fulltext#relatedArticles
- The vital role of health literacy. (2019). https://www.myamericannurse.com/the-vital-role-of-health-literacy/
- Resources for implementation. (2022).
- https://health.gov/our-work/national-health-initiatives/health-literacy/health-literate-care-model/resources-implementation
- Wittenberg E., et al. (2019). Nurse communication challenges with health literacy support. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776742/
