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14.1: Understanding your Health Care Choices

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  • Developing Health Literacy

    The U.S. Department of Health and Human Services (HHS) defines health literacy as "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." In a recent report by the HHS, improved consumer health literacy was determined to be an important component of health communication, medical product safety, and oral health.

    Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.

    Health literacy varies by context and setting and is not necessarily related to years of education or general reading ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment. With the move towards a more "consumer-centric" health care system as part of an overall effort to improve the quality of health care and to reduce health care costs, individuals need to take an even more active role in health care related decisions. To accomplish this people need strong health information skills.

    Skills Needed for Health Literacy

    Patients are often faced with complex information and treatment decisions. Some of the specific tasks patients are required to carry out may include:

    • evaluating information for credibility and quality,
    • analyzing relative risks and benefits,
    • calculating dosages,
    • interpreting test results, or
    • locating health information.

    In order to accomplish these tasks, individuals may need to be:

    • visually literate (able to understand graphs or other visual information),
    • computer literate (able to operate a computer),
    • information literate (able to obtain and apply relevant information), and
    • numerically or computationally literate (able to calculate or reason numerically).

    Oral language skills are important as well. Patients need to articulate their health concerns and describe their symptoms accurately. They need to ask pertinent questions, and they need to understand spoken medical advice or treatment directions. In an age of shared responsibility between physician and patient for health care, patients need strong decision-making skills. With the development of the Internet as a source of health information, health literacy may also include the ability to search the Internet and evaluate websites. according to the American Medical Association, poor health literacy is "a stronger predictor of a person's health than age, income, employment status, education level, and race." In Health Literacy: A Prescription to End Confusion, the Institute of Medicine reports that ninety million people in the United States, nearly half the population, have difficulty understanding and using health information. As a result, patients often take medicines on erratic schedules, miss follow-up appointments, and do not understand instructions like "take on an empty stomach."

    Vulnerable populations include:

    • Elderly (age 65+) - Two thirds of U.S. adults age 60 and over have inadequate or marginal literacy skills, and 81% of patients age 60 and older at a public hospital could not read or understand basic materials such as prescription labels
    • Minority populations
    • Immigrant populations
    • Low income - Approximately half of Medicare/Medicaid recipients read below the fifth grade level
    • People with chronic mental and/or physical health conditions

    Reasons for limited literacy skills include:

    • Lack of educational opportunity - people with a high school education or lower
    • Learning disabilities
    • Cognitive declines in older adults
    • Use it or lose it - Reading abilities are typically three to five grade levels below the last year of school completed. Therefore, people with a high school diploma, typically read at a seventh or eighth grade reading level.

    The relationship between literacy and health is complex. Literacy impacts health knowledge, health status, and access to health services. Health status is influenced by several related socioeconomic factors. Literacy impacts income level, occupation, education, housing, and access to medical care. The poor and illiterate are more likely to work under hazardous conditions or be exposed to environmental toxins.

    Economic Impact of Low Health Literacy

    In addition to the effects of low health literacy on the individual patient, there are economic consequences of low health literacy to society. After adjusting for health status, education level, socioeconomic status, and other demographics factors, people with low functional literacy have less ability to care for chronic conditions and use more health care services.

    Why Does Health Literacy Matter?

    Every day, people confront situations that involve life-changing decisions about their health. These decisions are made in places such as grocery and drug stores, workplaces, playgrounds, doctors' offices, clinics and hospitals, and around the kitchen table. Obtaining, communicating, processing, and understanding health information and services are essential steps in making appropriate health decisions; however, research indicates that today's health information is presented in ways that are not usable by most adults. "Limited health literacy" occurs when people can't find and use the health information and services they need.

    • Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available in our healthcare facilities, retail outlets, media and communities.
    • Without clear information and an understanding of the information's importance, people are more likely to skip necessary medical tests, end up in the emergency room more often, and have a harder time managing chronic diseases like diabetes or high blood pressure.

    Who Does Limited Health Literacy Affect? Who is affected?

    People of all ages, races, incomes, and education levels can find it difficult to obtain, communicate, process and understand health information and services. Literacy skills are only a part of health literacy. Even people with strong reading and writing skills can face health literacy challenges when:

    • They are not familiar with medical terms or how their bodies work.
    • They have to interpret or calculate numbers or risks that could have immediate effects on their health and safety.
    • They are voting on a critical local issue affecting the community's health and are relying on unfamiliar technical information.
    • They are diagnosed with a serious illness and are scared or confused.
    • They have health conditions that require complicated self-care.

    Health Promotion and Self Care

    Ideally we adopt behaviors and practices that promote health and prevent chronic disease. Through education and health promotion we learn behaviors and practices to manage our own basic health care. Health promotion involves education, policy, and support that helps us to make health choices and promote positive behavior and self-care. Self-care and health promotion involve the following:

    • health prevention practices, which help limit our need for formal interventions; we manage minor health concerns informally using self-care.
    • primary prevention such as brushing our teeth, breast and testicular self exam, vaccinations, etc.
    • managing uncomplicated injuries or illnesses with self diagnosis and treatment
    • using home remedies and OTC drugs.

    Self Care versus Formal Care

    The World Health Organizations defines self-care in the following way:

    ‘Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc), environmental factors (living conditions, social habits, etc.) socio-economic factors (income level, cultural beliefs, etc.) and self-medication.’

    Self-care improves as we come to know our body and pay attention to the signals it gives us so we can take appropriate actions. Self-care helps us rely less on formal medical intervention. When we are more knowledgeable about our body and health issues we are better able to make better decisions about self-care and seeking formal care.

    Examples of self-care are:

    1. Recognition of symptoms or conditions that occur frequently but may not require a doctor’s visit
    2. Performing monthly breast and testicular self-exams
    3. Learning first aid for common, uncomplicated injuries and conditions
    4. Checking blood pressure, pulse, and temperature
    5. Using home pregnancy tests, ovulation kits and HIV test kits
    6. Doing periodic checks for blood cholesterol
    7. Using home stool test kits for early colon cancer detection
    8. Using self-help books, tapes, websites, and videos
    9. Benefiting from relaxation techniques, including meditation, nutrition, rest, and exercise

    Formal Care: Health care professionals often need to be consulted if there is a serious accident or injury, severe trauma, sudden onset of symptoms, or if any symptoms are unusual and recur over time. Formal Care is accessing a local provider through a community or privatized hospital, clinic or medical practice. Formal Care is best and most effective when you are an active participant and informed. A partnership between the patient and health care provider is desirable. The goal should be an exchange of information and coordination on interventions and solutions. Formal Care is enhanced through health literacy.