Evidence-Based Practice: Individuals who have low health lit- eracy compared to those with higher health literacy were shown to have 59% more days of poor physical health and 52% more days of poor mental health per month. Additionally, there were 20% more chronic disease conditions reported in individuals who had low health literacy (CDC, 2018). Self-Assessment Quiz Question #1 “The extent to which individuals can locate, comprehend, and use information and services to make informed decisions and perform actions for their own health or those of others” is the definition of: a. Personal health literacy. b. Literacy. c. Organizational health literacy. d. Numeracy. Studies have shown that up to 80% of medication information is immediately forgotten afterward, and about 50% of the infor- Patients at risk Low levels of education and/or difficulties during school have a correlation with low health literacy (CDC, 2018). Although there is a relationship between literacy, numeracy, and health literacy, it is vital that healthcare professionals do not assume that a person who is well educated has a high level of health literacy. Medical terminology, anatomy, and physiology knowledge is specialized and is not considered common knowledge. Health conditions such as confusion, fear, pain, and those requiring complex self- care can also impact health literacy (CDC, 2022b). Assessment of every individual’s health literacy prior to providing patient teach- ing is imperative, and tools for this assessment will be discussed further in Chapter 3. Red flags for low health literacy As mentioned earlier, health literacy requires patient assessment prior to education. There are some indicators, or “red flags,” re - lated to persons with low health literacy. These factors can include repeatedly missed appointments and lack of following through with testing or referrals. Registration forms that are not complete, making excuses to avoid reading something, and an inability to provide an appropriate logical history may also be red flags. Ask - ing very few questions or asking many questions can also be an indicator. Low health literacy may also be shown in a failure to name or explain medications, noncompliance with medications, and recognizing medications visually rather than looking at their labels (AHRQ, 2020; Pacific University Oregon, 2022). Readiness to Learn One potential barrier to effective patient education is readiness to learn. Learning readiness is described as the ability of a person to acquire and comprehend knowledge, as well as apply that knowl- edge successfully. For patients, readiness to learn can be affected by their physical, emotional, experiential, and knowledge states. If there are deficiencies in the patient’s learning readiness, effec - tive teaching will be highly unlikely. Physical readiness can include health status, task complexity, physical abilities, and impact of the environment. Considerations for emotional readiness are motiva- tion, stress and anxiety, developmental level, social support, frame of mind, and risk-taking behaviors. Experiential readiness can in- clude orientation, position of control, cultural considerations, past Patient limitations Patients may have limitations that can affect their ability to learn and retain information. Low health literacy, discussed above, is one example. Physical limitations can also exist, such as pain or fatigue from illness or procedures. Limited mobility may impact the ability for return demonstrations. Sensory impairment such as vision or hearing loss may be a limitation for following or compre- hending communication. Conditions that alter cognition, recogni- tion, focus, concentration, and/or memory will also affect teach-
mation that is remembered is remembered incorrectly. The com- plexity of the information presented to the individual also impacts literacy. Eighty-four percent of people can understand medication instructions at a first-grade level, while 59% can comprehend the same information at a fourth-grade level, and only 8% of under- stand these instructions at a tenth-grade level (Agency for Health- care Research and Quality [AHRQ], 2020). Research has asked patients to describe their understanding of printed instructions on medication bottle labels. If instructions were on more than one label, 46% of patients didn’t understand the complete instructions. For patients who were identified as having adequate literacy, 38% did not understand at least one label. One study examined both understanding and demonstra- tion of taking medication. In this research, 71% of patients with low literacy showed verbal understanding of the label, and 89% of patients with adequate literacy understood it. Only 35% of pa- tients with low literacy could demonstrate the correct way to take the medication, while 80% of those who had adequate literacy showed an ability to correctly take the medication (AHRQ, 2020). Some populations, such as those with a language barrier or the young, are at a higher risk for low health literacy. Age disparities show that those younger than age 16 and older than age 65 have the lowest health literacy. Multiple studies have examined race and health literacy. Although there are some variations, Hispan- ics, Asians, Pacific Islanders, and Native Hawaiians are at risk for low health literacy. Other risk factors associated with lower health literacy include inability to work, low income, visual impairment, male gender, English as a second language, chronic physical or behavioral health issues, and social isolation (CDC, 2018; Pacific University Oregon, 2022). Self-Assessment Quiz Question #2 Which of the following statements is true regarding health lit- eracy? a. There are no age disparities related to health literacy. b. The use of medication labels is the solution for understanding. c. People with high literacy can have low health literacy. d. Health literacy is not associated with health outcomes.
experiences and coping, and ambitions. Knowledge readiness in- volves the person’s present knowledge base, learning disabilities, cognitive capability, and learning styles (Bastable, 2021). Self-Assessment Quiz Question #3 An example of a factor that is within the state of emotional readiness to learn is:
a. Health status. b. Past coping. c. Learning disabilities. d. Frame of mind.
ing and learning. Emotional limitations may include resistance to change, self-confidence, unrealistic goals, lack of motivation, or procrastination. Difficulties in communication or language barri - ers may also limit the patient’s ability to understand and learn (Bastable, 2021; Varmin et al., 2015).
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Book Code: RPUS3024
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