Limited Health Literacy Presents Hurdles To Decent Care

Ruzanna Harutyunyan's picture

People who struggle with poor reading and math skills experience problems understanding instructions from health care providers and adhering to treatment, according to a new research review.

“There is evidence that limited health literacy is associated with poorer access to health information and knowledge about the long-term benefits of preventive health care,” said Christian von Wagner, Ph.D., a research fellow in epidemiology and public health at University College London.

Based on surveys conducted in the United States, more than 75 million adults report limited health literacy — the ability to find and understand basic health information needed to make health care decisions. In addition to basic literacy and math skills, culture and knowledge of health topics influence a person’s health literacy level.

The review appears in the October issue of the journal Health Education & Behavior.


Using previously published research, lead author von Wagner and colleagues examined how health literacy levels influence a person’s ability and motivation to perform actions like finding health care, talking to providers and managing chronic illness.

“Adults with limited literacy often find it difficult to understand instructions about how to engage in unfamiliar health actions,” such as performing self-administered home-based screening tests, von Wagner said. He also noted that limited health literacy — and the shame and frustration that might accompany it — also negatively affects a patient’s ability to share decisions with health care providers.

In addition, the review found that people who have trouble comprehending written information benefit less from health education and preventive health campaigns. One study of 445 women found that 39 percent of those who read at or below a third-grade level did not know the purpose of mammograms, compared with 12 percent of those reading at or above a ninth-grade level.

A person with low health literacy also tends to have more difficulty managing the complex tasks associated with managing chronic illness or taking multiple medications, the authors say. In one study of 204 HIV patients, patients with the lowest literacy levels had the highest rates of failing to take antiretroviral medications as prescribed.

Amanda Hinnant, Ph.D., a health literacy researcher and assistant professor at the University of Missouri, called the research “an incredibly useful review of the links between health literacy and health outcomes.

“They advocate addressing health outcomes relating to community health and looking at health literacy in health management for the general population. With the debate about health care reform raging, the authors couldn’t be timelier with their suggestions,” Hinnant said.