Health Literacy: Critical Opportunities for Social Work Leadership in Health Care and Research
Liechty, Janet M., Health and Social Work
Health literacy is defined as the degree to which an individual has the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Ratzan & Parker, 2000; U.S. Department of Health and Human Services, 2000). According to the 2003 National Assessment of Adult Literacy (NAAL), more than one-third of adults in the United States do not have adequate health literacy to manage their own health care needs (Kutner, Greenberg, Jin, & Paulsen, 2006); and health literacy has garnered much attention for its pivotal role in health care access and quality. A growing body of research shows that low health literacy is related to poorer quality of care and poorer health outcomes, as synthesized in landmark reports from federal agencies such as the Agency for Healthcare Research and Quality (AHRQ) (Berkman et al., 2004) and in the Institute of Medicine report Health Literacy: A Prescription to End Confusion (Nielsen-Boblman, Panzer, & Kindig, 2004). In addition, improving health literacy is one of the goals of the new Healthy People 2020 report (U.S. Department of Health and Human Services, 2010a); and the federal government recently released a National Action Plan to Improve Health Literacy (U.S. Department of Health and Human Services, 2010b).
The ramifications of low health literacy should be a central concern of health social workers. Low health literacy often coexists with other social disadvantages such as low levels of education, lack of medical insurance, and poverty, exacerbating its effect on vulnerable populations frequently served by social workers. Health literacy has also been viewed as a possible driver of health disparities (Berkman et al., 2004) and a potential mechanism through which social factors such as income, education, language, and immigration status affect poor health outcomes (Nielsen-Bohlman et al., 2004).
However, much can be done to ameliorate the negative effects of low health literacy. Research suggests that many of the negative effects of inadequate health literacy can be mitigated within the health care system through patient education and support, systems improvements, and health care provider accommodations (Kandula et al., 2009; Volandes et al., 2008). Health social workers should be at the forefront of these efforts, and most health social workers are routinely engaged in a plethora of health literacy promotion and accommodation activities with patients and families. However, the concept of health literacy has received very little attention in the social work literature, despite its salience to health inequalities and cultural and linguistic competence and the growing body of research about health literacy in the allied fields of medicine, nursing, and public health (see Figure 1). This puzzling gap in the social work literature reflects missed opportunities for social workers to contribute their expertise to the evolving field of health literacy and to strategically align their work with national and organizational priorities. This article begins to close this gap by providing an overview of health literacy and its relevance to social work, summarizing current social work literature on health literacy, and presenting several opportunities for health social workers to incorporate the concepts and tools of health literacy into their practices with patients and families.
HEALTH LITERACY OVERVIEW
Assessment and Prevalence of Low Health Literacy
In 2003, the NAAL survey included a new Health Literacy Supplement Assessment to estimate health literacy in the general population (Kutner et al., 2006). Health literacy was measured on the basis of ability to complete health-related information and processing tasks across prose, document, and numeracy aspects of literacy. The health-related tasks were categorized into three domains: (1) clinical tasks (for example, correctly interpreting instructions for taking a medication), (2) preventive tasks (for example, comprehending recommendations for gender- and age-related preventive medical services), and health care system navigation (for example, understanding eligibility requirements for health-related public services). …