Look for clues that patient comprehends information

Take time to ensure capacity for understanding

Physicians pressed for time need to note whether their patients truly comprehend what they're being told and what they read about their medications; deficient health literacy is being counted as one contributor to health care disparities in some populations.

"Health literacy" is defined by the Institute of Medicine and the U.S. Department of Health and Human Services Healthy People 2010 as the degree to which a person has the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

A 2003 study by the National Center for Education Statistics indicates that more than one-third of adult Americans have levels of health literacy that are below what is required for them to understand typical medical information.1

But health literacy shouldn't be equated with the ability to read or even educational level, says Michael Mackert, PhD, a University of Texas at Austin assistant professor of advertising who has conducted extensive research into health communications and health literacy.

"A lot of [research] has looked at the reading level of the text included in the body of advertising, and there are a lot of things that work their way into ads that someone with lower health literacy might not comprehend," he says. "Health literacy includes the science behind the literature, so you might have someone who is literate, but might not understand what a randomized, blinded trial is."

Mackert says a class he taught recently researched health literacy as it applies to pharmacist-customer communications, and he says the students came up with several tools that can help different patients better understand their medications, the reasons for the drugs, and the effects the drugs might have.

"The students created a checklist for pharmacists that included skills that are effective in providing information — like drawing pictures, for example — and also clues that can help the pharmacist identify people who were potentially health illiterate," he says.

For example, a patient might nod in the affirmative when asked if she understands her medication and the science behind it. But then, when asked what medications she takes, must look at the pills because she identifies them as "the purple one" or "the little [or big] pills."

The average informed consent document is written at a college reading level, but numerous studies have shown that half of American adults can only comprehend material written at the 8th-grade level or below.

In cases where pharmacists or physicians might suspect a lack of comprehension, follow-up phone calls can be effective in reinforcing or clarifying information the patient might not have grasped fully during the first office or pharmacy visit.

"Doctors, nurses, and pharmacists are always pressed for time, and nobody has the time to deal with a lot of new questions, but the extra two minutes could save a lot of time in follow-up questions by phone, or a deteriorated condition because they didn't understand the instructions," Mackert adds. "If you build up their knowledge once, you don't have to constantly go back over the same questions."


For more information, contact:

  • Michael Mackert, PhD, assistant professor, department of marketing, University of Texas at Austin. E-mail: mackert@mail.utexas.edu.
  • National Center for Education Statistics. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. Available on-line at http://nces.ed.gov.