Literacy can be defined as “an individual’s ability to read, write, and speak in English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and to develop one’s knowledge and potential.”1
Over the last decade, health literacy has become a vibrant area of research. Investigators have elucidated the prevalence of limited health literacy and the relationship of limited health literacy with patients’ knowledge, health behaviors, health outcomes, and medical costs, as summarized in reports by several prominent organizations.2
According to a United Nations (UN) report more than 860 million adults and 113 million of children worldwide do not have access to literacy, and approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes, and that is highly serious considering that when a person agrees to receive health care from any health professional, the patient is also expected to participate properly in decisions involving the advice received for themselves or a family member.
Moreover, certain groups have a special high prevalence of low literacy. Low literacy may impair functioning in the health care environment, affect patient-physician communication dynamics, and lead to substandard medical care.3 The Agency for Health Care Research and Quality (AHRQ) for 2007 says there exists an association between poor understanding of written or spoken medical device, adverse health outcome, and negative effects on the health of the population. They include people who lack education, persons of certain racial or ethnic groups, and low income families.4
These barriers pose difficulties in understanding and using medical information and how these affect people’s ability to respond to illness. For instance, patients with poor literacy skills usually avoid scheduling or even attending doctor appointments due to intimidation from their superiors or to any medical forms to be filled in, these can impact or lead to a low health outcome because their of limited knowledge on medical terms and concept.
Moving on to certain racial and ethnic groups, according to the AHRQ for 2007, the U.S. Census Bureau estimated that the United States had almost 38.8 million Blacks or African Americans (12.9% of the U.S. population); more than 45.5 million Hispanics or Latinos (15.1%); almost 13.4 million Asians (4.4%); more than 0.5 million Native Hawaiians and Other Pacific Islanders (NHOPIs) (0.2%); and more than 2.9 million American Indians and Alaska Natives (AI/Ans) (1.0%), of whom 57% reside on Federal trust lands. Racial and ethnic minorities are more likely than non-Hispanic Whites to be poor or near poor.5
Among certain racial groups, Hispanics, Blacks, and some Asian subgroups are less likely than non-Hispanic Whites to have a high school education. African-Americans, America Indians, American Natives received worse care than Whites for about 40% of measures and Hispanics received worse care than non-Hispanic Whites for about 60% of core measures.5
Some investigations report a strong correlation between health outcomes and income. People with higher incomes or personal wealth, and who live in a healthy and safe environment, have on average longer life expectancies and better overall health outcomes. Conversely, those with lower incomes are associated with many other factors contributing to poor health outcomes, including risky health behaviors, lower levels of education, substandard housing, food insecurity, and lack of health insurance coverage.
Finally, low literacy has been associated with several adverse health outcomes, amongst which low health knowledge, increased incidence of chronic illness, poorer intermediate disease markers, and less than optimal use of preventive health services, have been identified. Intervention studies6 conducted to mitigate the impact of low literacy on people’s health have shown some improvement patient understanding health terms, leading to a better use of health care services. Future research, however, using more rigorous methods, is required to better define these relationships and to guide development of new interventions.