Magazine article Drug Topics

How R.Ph.S Can Meet Challenges Posed by Low-Literacy Patients

Magazine article Drug Topics

How R.Ph.S Can Meet Challenges Posed by Low-Literacy Patients

Article excerpt


It is estimated that as many as 50% of U.S. adults function at or below marginal literacy levels. According to Ann Marie Brooks, M.S.N., St. Mark's Hospital Diabetes Center, Salt Lake City, those considered to have low health literacy are completely illiterate or read at or below the sixth-grade level.

Low health literacy can make it difficult for patients to understand and follow instructions from healthcare professionals. Strategies for serving low-literacy patients were discussed at a seminar given during the American Pharmaceutical Association's annual meeting, held recently in Philadelphia.

Donna Dolinsky, Ph.D., professor and director, social and administrative sciences, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, lists foreign citizenship (not speaking English), poverty, and old age (older than 60 years of age) as risk factors for low health literacy. She pointed out that poverty is not always a predictor of health literacy, however.

Persons with a low level of health literacy may have cultural or religious issues that make them unwilling or unable to comprehend U.S. preventive medicine guidelines, said Brooks. For example, Polynesian cultures do not believe in preventive care because they do not believe in disease, while Hispanic Catholics see illness as punishment.

Low health literacy can have socioeconomic and psychosocial consequences. Illiterate or moderately literate patients have lower health status, compared with persons with greater literacy skills, Dolinsky said. Those with low health literacy have less positive attitudes toward preventive care. They have poorer disease managemeet skills than more literate patients, in terms of their ability to follow a complicated therapeutic regimen. For example, they may have difficulty understanding how to manage diabetes.

Their negative attitude toward preventive care and poor disease management skills lead to a higher hospitalization rate and higher healthcare costs compared with educated persons, Dolinsky added. Those with low health literacy make more unnecessary office visits, because they may not understand that the doctor cannot treat their condition.

Low health literacy is shameful, in the same way that obesity is shameful, Dolinsky said. Feelings of shame make patients very reluctant to admit to this problem, and they become very good at disguising it. Signs of poor health literacy, she continued, include referring to medication by the color of the pill, not by the drug name. Patients may pretend to read handouts and other material, even though it was handed to them upside down, or they may simply put the materials away without looking at them. …

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