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Unit 2: What is Health Literacy and its Societal Impact?

From KNILT

Case Study

Remember Stella? You are a community-based social worker you will be working with her in her home. She is a 35 year-old Asian immigrant from China who has been in the country for 15 years. She experienced a serious fall at work and spent several months in the hospital and a rehabilitation being treated at a facility before being discharged home into the community. Prior to her injury, she worked in her family business a small retail store. She is married with children. Speaks English well enough to communicate but has some limitations. She has difficulty managing community supports and her condition because she must use a wheelchair for now. Recall your initial thoughts from the last unit on how you would work with her. Do you still have the same opinion? What do you think is going on here? How would you help her? Think about it as you work through the unit and share your thoughts on the course blog discussion for unit 2.

Introduction

What is Health Literacy?

The Institute of Medicine (IOM) 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 (IOM, 2004). Health literacy refers to the understanding and use of information to help people access health resources, navigate health systems and make the right health decisions. It also includes the reading, writing, arithmetic and communication skills necessary for an individual to take part in and navigate the health care system.

Low Health Literacy is on the opposite side of health literacy where people have difficulty using the health information provided to them by health care professionals, media and within their communities. Low health literacy affects an estimated 30-90 million people, elderly, minorities and immigrants are thought to be disproportionately affected but all people are affected by low literacy.

Why is Health Literacy Important?

It is a social problem that affects individual’s ability to: navigate health systems, manage conditions (e.g. diabetes) and medication, complete medical forms or provide a medical history, adopt health lifestyles like proper diet or exercise and act on health information. Health Literacy is a greater predictor of health outcomes than income, employment statistics, race/ethnicity and education. There is a relationship between health literacy and increased health disparities, higher mortality rates and negative health outcomes. It results in medical errors, low treatment and compliance rates from poor provider-patient communication, less preventive care and increased usage of emergency care, hospitalizations and greater costs to communities and government.

Who may have Low Health Literacy?

ANYONE! People with low health literacy may be educated, employed in various different fields, even health care but be unable to process information appropriately or in high stressed situations. Health information can overwhelm people with advanced literacy skills. It is important to be mindful that people present differently.

How is Low Health Literacy Assessed?

Research suggests a correlation between low health literacy and feelings of shame. As a result, the consensus is it is inappropriate to formally assess clients for health literacy. There are informal methods that health professionals can use to conduct assessments. For social work professionals the interview check in period provides a perfect opportunity to observe and make inquiries without seeming intrusive. Two strategies that have proven to be effective are observation for red flags and unobtrusive questioning.

Observation- When working with clients, look for red flags that may be signs of low health literacy such as: frequently missed appointments, asking few questions, lack of follow through and non-compliance with medication, interventions or referrals, inability to identify medications or explain their use, inability to complete forms and paperwork.

Conversation- When speaking with clients, asking questions as part of a normal conversation is the most effective way to assess client health literacy needs. For example: Ms. Smith, what do you like to read? Or Understanding and remembering medications can be very frustrating for some people. Has it ever been a problem for you? Informal assessments are common in social work practice. Clients may not feel ashamed or unwilling to talk if they approached in this manner. Their response is likely to provide adequate information to gauge whether or not a literacy intervention is needed without being intrusive.

Objectives

  • Participants will understand health literacy and its societal impact
  • Participants will understand the social worker's role in identifying client's health literacy needs
  • Participants will develop an informal health literacy assessment tool

Purpose

Health literacy is a major concern in the United States. Increasing health literacy is a goal of Healthy People 2020 (CDC, 2014). Understanding health literacy, its impact, who it affects and knowing how to recognize the signs of low literacy is essential for social work practitioners. Giving formal assessments using validated tools are frowned upon because of the shame that clients experience. As a result, practitioners must use informal strategies in order to assess clients health literacy needs. Knowing client’s health literacy needs are important because it allows social workers to move forward in their work with clients. For instance, health literacy skill building can be included as part of the care plan.

In this unit participants will examine health literacy and its impact through the social work lens. They watch a video, read articles, do activities and examine the magnitude of the problem and the social workers role in assessing low literacy.

Engage

Apply

  • Take the health literacy quiz

Reflect

  • In a word document or online journal reflect on what you learned in this unit, how you learned it and what additional info you would like to know about health literacy. Think in context of your work experiences and how the knowledge would be applicable.

References and Resources

Androus, M. & Roth, M. (2009). Health literacy: A literature review. Pharmacotherapy, 22(3): 282-302.

Chew, L. et al. (2004). Brief questions to identify patients with inadequate health literacy.. Family Medicine, 588-594.

Davis, T. C., Wolf, M. S., Bass, P. F., Middlebrooks, M., Kennen, E., Baker, D. W., Bennett, C. L., Durazo-Arvizu, R., Bocchini, A., Savory, S. and Parker, R. M. (2006), Low Literacy Impairs Comprehension of Prescription Drug Warning Labels. Journal of General Internal Medicine, 21: 847–851.

The Institute of Medicine. Health Literacy: A Prescription to End Confusion - Extended Video.

The Institute of Medicine (2004). Health Literacy: A Prescription to End Confusion Report.

Joint Commission. (2007). Improving health literacy.

Liechty, J.M. (2011). Health literacy: Critical opportunities for social work leadership. Health and Social Work, 36(2):99-107.

McCray, A. (2005). Promoting Health Literacy. Journal of American Medical Information Association, 12:152-163.

Safeer (2005). Health Literacy: Gap between physicians and patients. American Family Medicine, 22(3): 463-468.

Wolf, Gazmararian & Baker (2005). Health literacy and health status among older adults. Archives of Internal Medicine, 165: 1946-1952.

Navigate

Proceed to Unit 3: Key Factors of Health Literacy

Return to Unit 1: Getting Started

Course Home Page: Health Literacy for Social Work Professionals

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