Imagine trying to figure out how often to take your medication if you are just learning to speak English. Or applying for insurance coverage for your children if you can’t read the application.
For millions of Americans who struggle with low health literacy, these kinds of situations are very real.
And they can affect their everyday health choices—like when to see a doctor, whether to give up smoking, how to read the labels on medicine and food, finding the nearest health center or paying their medical bills.
When many people hear the term ‘health literacy,’ they may think of reading and writing. These are an important piece, but health literacy involves many more skills, such as calculating numbers, communicating effectively with health care professionals, and using medical devices.
“We ask learners to do basic math in health literacy, which includes fractions and percentages. We also ask them to do a lot more critical thinking and decision-making,” says Sara Nye, manager of the Health Education and Literacy (HEAL) program at the nonprofit Literacy for Life.
The HEAL program, which is funded by the Williamsburg Health Foundation, offers eight-week sessions in Williamsburg, Va., for people wanting to improve their health literacy skills. The program has also partnered with other agencies to offer classes in Newport News, Va.
Many of the people who enroll in the program are native speakers of another language who are learning English. But immigrants are not the only ones who struggle with low health literacy.
Minorities and people with low income are more likely to have lower health literacy levels. Even older adults can have difficulty with health literacy, especially using printed material, reading charts or forms, or interpreting numbers.
HEAL targets all of these people.
“Low health literacy includes everyone with regular literacy challenges,” says Nye. “But because we ask them to do some more advanced skills it can actually incorporate folks who would, on a regular literacy test, score above that low level.”
Each class is only an hour-and-a-half long, but participants aren’t expected to learn everything.
“When I think about what it means to be a health-literate human, it doesn’t necessarily mean knowing every single thing about being healthful,” says Nye. “It means knowing who to ask or where to look things up when you have questions, and knowing the appropriate places to go when you need care.”
Impact of Low Health Literacy
People with low health literacy are less likely to get a flu shot or use other kinds of preventative care. They have more difficulty understanding medical instructions and drug labels. And they are more likely to end up in the hospital and have worse overall health.
Low health literacy can even affect the way people manage chronic health conditions like asthma, diabetes and high blood pressure.
“There was a woman who had been living with diabetes for a really long time that never knew how to read a nutrition facts label or the ingredients list on the food that she was buying,” says Nye. “So when she learned how to do that at the HEAL class, that was a huge success for her and for us.”
HEAL includes three levels, from beginner to advanced. The topic for each class is the same for all levels, but students work on different aspects of the topic.
“The first lesson in our curriculum is about healthy eating and nutrition, so all three levels will be learning about healthy eating and nutrition,” says Nye. “But the concepts and activities become a little bit more in depth as you work through the levels.”
In the first class students learn about the government’s MyPlate nutrition guide. While beginning students may work on vocabulary building, more advanced students analyze nutrition facts labels and have discussions about healthy eating.
People in the HEAL program also learn about many parts of the health care system, things many people have struggled with at some point in their life.
“We spend a whole lesson discussing medication,” says Nye. “Over-the-counter versus prescription, how to interpret the labels, how to talk to a pharmacist, questions to ask the pharmacist and doctor about medication.”
Other classes touch on what to expect before, during and after a visit to the doctor’s office, and deciding whether to go to the emergency room or urgent care. This can change how people access health care.
“A lot of people will go the ER, not only because it’s the only resource, but because the staff at the ER will fill out the forms for them,” says Nye. “But we’re able to build their confidence in asking for help, as well as filling out those basic forms.”
Educating Health Professionals
The HEAL program also educates health professionals about health literacy and its impact on their patients’ health and the economy.
Research has found that low health literacy is estimated to cost the U.S. economy between $106 billion and $238 billion each year through increased health care costs and lower quality of care.
“We provide strategies for identifying patients that have low literacy,” says Nye, “and also some strategies for working with folks who have low literacy once they identify them.”
A lot of this has to do with improving communication, such as teaching health professionals how to overcome language barriers—beyond just reaching out to an interpreter.
They can use “pictograms to help a patient understand what they’re supposed to do next,” says Nye. “Not just giving them a packet of information to read that’s very complicated and complex.”
Health professionals learn how to walk patients through procedures—like physical therapy exercises or how to change a bandage—so the patients can actually see what the process looks like.
Then there are the cultural aspects of health care.
“The way we gesture, the way we point, the way we communicate with family members,” says Nye.
“They’re all things for medical professionals to keep in mind.”
A review of the HEAL program by researchers at the Schroeder Center for Health Policy at the College of William & Mary showed that people going through the program remembered much of the information they had learned and built up their confidence.
But it’s the little things that really show the power of greater health literacy. Like when Nye gets a phone call from one of the students asking if they should go to the clinic or emergency room for an issue.
“Just the fact that they’re reaching out for that information, that they’re asking and not just guessing,” says Nye. “I think that’s fantastic.”