Academic journal article Women's Studies Quarterly

Stories of Women, Words, and Well-Being: The Effect of Literacy on Women's Health

Academic journal article Women's Studies Quarterly

Stories of Women, Words, and Well-Being: The Effect of Literacy on Women's Health

Article excerpt

She came in complaining of being dizzy. Her head hurt and she felt tired. It had been like that for days. Maybe weeks. She couldn't remember. Even though she had not seen this doctor before-they came and went at this teaching hospital where the poor people could afford to go-she knew the drill. She brought out a clear plastic bag, with eight treasured bottles. Eight bottles that the young resident started pulling out one by one.

"How many of these do you take?"

She looked at the bottle. "One a day."

"And these?"

A pause. "One a day."

The doctor kept holding out bottles, and asking. Then she put three bottles together and looked at the patient. "Do you see these three? They are all the same medicine. They are all for your blood pressure."

"Oh," she said.

"This little bottle has 40-milligram pills, these other two have 10 milligrams, but they are the same medicine. And see these two other bottles? They are both for your cholesterol."

"You were taking too many medicines. I think that was probably causing your dizziness."

The doctor poured pills from bottle to bottle, discarding the empty, redundant ones. She went over the medicines with her. It was a little confusing because one pill she was supposed to cut in fours, but only when she finished taking all the pills from some other bottle.

"You got it?" the doctor asked.

She nodded. But her mistake had damaged her health and her pride.

She is not alone.

The 1992 National Adult Literacy Survey (NALS), the most comprehensive picture of American literacy to date, found that approximately one fourth of American women scored in the lowest level and could be considered functionally illiterate (Kirsch, Jungeblut, Jenkins, & Kolstad, 1993). These women have trouble interpreting bus schedules, understanding brief newspaper articles, or even doing something as simple as signing a Social Security card. A disproportionate number of low-literate persons are elderly, poor, minorities, and live in inner cities (Kirsch et al., 1993).

According to NALS, about three out of four people in the lowest reading levels reported living with chronic physical, mental, or other health problems (Kirsch et al., 1993). These problems resonate through women's lives. Inadequate literacy skills hamper women's abilities to manage chronic diseases such as hypertension (Williams, Baker, Parker, & Nurse, 1998), asthma (Williams, Baker, Honig, Lee, & Nowlan, 1998), diabetes (Williams, Baker, Parker et al., 1998; Schillinger et al., 2002), and HIV (Kalichman, Ramachandra, & Catz, 1999) and increase their risk of hospitalizations (Baker, Parker, Williams, & Clark, 1998). Low-literate women are also less likely to seek preventive care such as mammography screenings (Davis, Berkel, Holcombe, Praminik &Diver, 1998) and pneumonia vaccinations (Jacobson, Thimas, Morton, Offutt, Shevlin, & Ray,, 1999).

Low literacy affects women's health literacy, or "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (Seiden, Zork, Ratzan, & Parker, 2000). As complexity increases in prevention, diagnosis, and treatment of disease, the burden placed on the patient with low health literacy increases in proportion.

Patients today must be able to manage increasingly complex medicine regimens. They are often given multiple drugs with different dosing schedules, differing interaction precautions, differing contraindications, and possible generic substitutions with names other than those the physician used in her instructions. The problem can also be seen in the increasing complexity of preventive information that, for example, asks patients to differentiate between LDL and HDL cholesterol.

We work in a research team that examines the problems faced by patients with low health literacy and attempts to find solutions. …

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