A common definition of health literacy is the ability to read, understand, and act upon health information.
Reading and understanding
Many of us in the pharmaceutical industry build our patient education programs on the idea that consumers or patients will proactively seek information about their condition, or perhaps will receive it from a healthcare provider. This information helps patients ask questions about their condition and learn how to manage it. As an industry, we are becoming more and more aware of the need to match the language and design of patient education materials to the general audience that reads at or below the eighth-grade level. This is good news for all of us.
But it is important for us not to become complacent. While reducing the reading level of our materials is laudable, there is more to supporting health literacy than simplifying copy. In a recent article in the Journal of Communication in Healthcare, author and long-time advocate for health literacy Rima Rudd advocates for a more extended view of health literacy—a view that takes into account the complex demands our healthcare system makes on its patients. It reminds me of work I did before becoming an educator, and I realized there is much I can bring with me from my former therapeutic role.
Before I became a health educator, I worked as a certified therapeutic recreation specialist. In that role, I helped link patients to leisure activities that could enhance their physical, cognitive, and emotional functioning. Before a recreation specialist chose a patient's therapeutic activity, we considered his or her preferred leisure pursuits and then conducted a task analysis. This required the specialist to consider every step in an activity and determine whether the patient could complete it or adaptation was required.
For example, I worked with a person with Alzheimer's disease who enjoyed playing bingo. Because of her condition, she had trouble remembering the numbers called and maintaining her concentration to scan a board with 24 numbers listed. She knew how to play but was unable to easily participate. I adapted the game by handing her a visual cue when I called out the number—an index card listing the number that had been called. This helped her remember, scan, and match the number listed on her board. I also called the numbers more slowly and allowed more-than-usual normal time to pass before calling the next number, to give her the extra processing time she needed. These adaptations made use of her remaining strengths. By our supporting her challenges, she was able to return to playing a game that she loved.
A day in the life
In the same way, health literacy researchers are now analyzing health-related tasks to find those that might present challenges for patients with low health literacy skills. For example, many of our industry communications focus on helping patients understand their medication regimens and adhere to treatment plans.
Think about the tasks associated with managing a medicine regimen. Picture Ray, a 70-year-old man who takes oral medications to control blood pressure and arthritis pain. He also takes basal and mealtime insulin to control blood sugar. Ray has to:
- Read prescription labels and additional stickers on the pill bottles to determine the number and frequency of doses and to learn about warnings and other important information
- Use a clock or other reminder to plan the time of each dose
- Calculate insulin doses according to the meal he will be eating
- Measure insulin doses before injecting
- Correctly use his device to inject insulin
- Remember to carry his medication and diabetes supplies with him if he is having a meal out
- Use a calendar or other reminder item to plan for refills
- Call or visit the pharmacy to reorder his medication
Each of the tasks listed above has more than one step and is therefore even more complex than implied here. This regimen requires:
- Reading skills to understand labels and medication information
- Numeracy skills to calculate time, dosing, and blood glucose levels
- Writing skills to track blood sugar levels and noted reminders
- Visual-spatial skills to follow the instructions for using an injection device
- Manual dexterity to manipulate the pill bottles and device
- Planning and communication skills to reorder medications, whether by phone or in person
Seeing our patients in context
This type of regimen—not an uncommon one—requires much more of patients than our simpler health literacy definition of reading, understanding, and acting on health information. It is time to move from theory to practice and consider ways in which health literacy is applied in daily life. Our challenge is to find ways to more comprehensively assess our patients’ health education needs. Our planning efforts can be much more successful if we develop solutions that help them overcome the types of challenges that can exist at each step of their treatment plan.
Laura Wilson, M.Ed.
SVP, Health Education