Illiterate Patient

[Lynn Hepler]

Illiteratemay be used in both specific and general senses. When used specifically, it refers to the inability to read or write. In a more general sense, illiterate may signify a lack of familiarity with some body of knowledge (as in being "musically illiterate") or indicate a lack of competence in or familiarity with literature.

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The assessment of a measure of chronic pain, should be reliable, valid and sensitive to change. Our study evaluated the reliability of 3 pain scales, visual analogue scale (VAS), numerical rating scale (NRS) and verbal rating scale (VRS) in literate and illiterate patients with rheumatoid arthritis (RA). Patients with RA attending an outpatient rheumatology clinic were interviewed and asked to score their pain levels on the 3 pain scales. The scales were presented in random order, twice, before and just after a regular medical consultation. Ninety-one patients were studied (25 illiterate and 66 literate). The Pearson product moment correlation between first and second assessment was 0.937 for VAS, 0.963 for NRS and 0.901 for VRS in the literate patient group and 0.712 for VAS, 0.947 for NRS and 0.820 for VRS in the illiterate patient group. These results indicate that the NRS has the higher reliability in both groups of patients.

Nurses have a unique opportunity to provide help to illiterate patients. With good listening, observation, and teaching skills, nurses can contribute significantly to the quality of care illiterate patients receive. They can influence long term recovery and patient compliance. It is important to teach when a "teachable" moment has arrived. For instance, when patients ask questions, they are usually ready to learn and an environment conducive to learning can be created. "Teachable" moments can occur at any time during hospitalization. The discharge interview is not the point at which to begin instructions. Discharge teaching should be a review of all the teaching that has been going on during hospitalization.

Health literate organizations make it easier for people to navigate, understand, and use health information and services. For these health care organizations, health literacy is a cultural value modeled by leadership and integrated into all aspects of planning and operations.

Patients need help learning how to manage their health day to day. Health care providers can facilitate this learning by offering self-management support. Examples of how health literacy strategies can be used when delivering self-management support include:

Feedback from patients and caregivers is key to building and improving health literate organizations. Health literate care systems engage patients in their health care and support patients and caregivers as partners in quality improvement.

Throughout this essay, I will consider an argument frequently used to justify paternalistic behavior toward a specific class of persons: illiterate people. The argument states that illiterate people are uneducated, lack information and understanding, and are thus unable to make decisions. Therefore, it is argued, paternalism in their case is justified. The conclusion is that illiterate persons cannot be autonomous. The justification for this view is based on an a priori attitude: since it is impossible to communicate, physicians should decide which kind of treatment the illiterate patient should receive. This argument is frequently used even though its proponents may not be aware of its implications. Given the importance and uncritical acceptance this argument has in Argentina, and also in other Latin American countries, I think it is relevant to analyze carefully what it means. I propose a thorough analysis of this argument, of its implications and an evaluation of whether it is acceptable.

Health literate healthcare organizations make it easier for people to navigate, understand, and use information and services to take care of their health. This page displays the many AHRQ resources that can assist healthcare systems address health literacy and each of 10 attributes of health literate healthcare organizations.

Being a health literate organization is more than initiating a few projects that address health literacy; it means that health literacy is an organizational value. Health literacy leaders: make it clear that effective communication is a priority across all levels of the organization; cultivate health literacy champions throughout the organization; and set goals for health literacy improvement, provide incentives to achieve those goals, and establish accountability for outcomes at every level of the organization.

Health literate healthcare organizations ensure that health literacy is fully integrated into all of their activities, and that health literacy informs both strategic and operational planning. Appropriate measures to evaluate specific health literacy initiatives are developed and used. In addition, measurement of overall organizational performance assesses success with vulnerable populations such as those with limited health literacy.

Health literate organizations include members of the populations they serve, especially those with limited health literacy, on governing boards, advisory groups, and design teams. This increases the chances that materials, programs, and services will meet the needs of patients and families.

Effective spoken communication between patient and families and healthcare professionals and staff is a cornerstone of health literacy. Health literate healthcare organizations create an environment that promotes and supports the adoption of evidence-based communication strategies, including strategies to be culturally and linguistically competent.

High-risk decisions, situations, and transitions demand more attention to health literacy. Health literate healthcare organizations identify which situations merit heightened safeguards and have standards and processes in place to ensure there is no miscommunication.

Before making healthcare decisions, consumers need information about their out-of-pocket costs. Health literate healthcare organizations inform consumers about the costs of care in advance, and refer people to programs that can help make care affordable.

Internet Citation: Ten Attributes of Health Literate Health Care Organizations. Content last reviewed January 2024. Agency for Healthcare Research and Quality, Rockville, MD.

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Telehealth solutions should be available also for elderly patients with no interest in using, or capacity to use, computers and smartphones. Fourteen elderly, severely ill heart failure patients in home care participated in a telehealth study and used digital pens for daily reporting of their health state--a technology never used before by this patient group. After the study seven patients and two spouses were interviewed face-to-face. A qualitative content analysis of the interview material was performed. The informants had no experience of computers or the Internet and no interest in learning. Still, patients found the digital pen and the health diary form easy to use, thus effortlessly adopting to changes in care provision. They experienced an improved contact with the caregivers and had a sense of increased security despite a multimorbid state. Our study shows that, given that technologies are tailored to specific patient groups, even "the digital illiterate" may use the Internet.

Methods: We performed a prospective cross-sectional study with case record review of 127 consecutive patients with RA attending one centre. All patients completed the Rapid Estimate of Adult Literacy in Medicine (REALM) screening test. This 66-word recognition test provides an estimate of reading level in less than 3 min. Demographic data were collected by interview and case record review. Function was assessed with the Health Assessment Questionnaire (HAQ) and depression with the Hospital Anxiety and Depression (HAD) scale, both sent prior to clinic attendance. Social deprivation was assessed with the Carstairs index.

Results: Four patients refused to participate. Of these, three stated they were unable to read. Ninety-seven women and 26 men agreed to be interviewed. All but two were Caucasian. Median age was 56 yr (range 19-77 yr) and median disease duration was 10 yr (range 1-60 yr). Median number of previous disease-modifying anti-rheumatic drugs (DMARDs) was two. Eighteen (15%) patients were functionally illiterate, with a REALM score of less than 60. Sex, age, disease duration and numbers of joint replacements and previous DMARDs were not influenced by illiteracy. Illiteracy led to more anxiety (P=0.011), but did not affect HAQ score (P>0.5). Illiteracy was more common in the deprived (P=0.0064). Illiterate patients had three times more hospital visits compared with age- and sex-matched RA controls over the previous 12 months.

Conclusions: One in six of our patient population are illiterate and would struggle to cope with patient education materials and prescription labels. These patients had significantly more hospital visits but equal function, suggesting that additional resources be directed towards these individuals. The REALM test is quick and easy to administer and allows us to identify patients who may require more appropriate literature.

FLACC is a behavioral pain assessment scale used for nonverbal or preverbal patients who are unable to self-report their level of pain. Pain is assessed through observation of 5 categories including face, legs, activity, cry, and consolability.

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