Health Literacy as a Tool to Improve the Public Understanding of Alzheimer’s Disease

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Citation:

Pages 34 - 40

Author(s):

Fred A. Kobylarz, MD, MPH, Alice Pomidor, MD, MPH, and Andrew Pleasant, PhD

Introduction

The ultimate goal of health literacy is to improve care by enhancing the patient’s quality of life, maximizing clinical outcomes, and reducing inequities in health.1,2 Successful restructuring of the healthcare system to make it more effective, efficient, and equitable demands that health literacy be integrated as a key source of theoretical and empirical data regarding patients’ needs and wishes. This applies across the life course, but it is especially true for the increasing numbers of older adults who must deal with the medical care system the most, yet often comprehend medical information the least.

Nearly nine out of ten people in the United States do not have the level of proficiency in health literacy skills necessary to successfully navigate the healthcare system.3,4 According to the National Assessment of Adult Literacy (NAAL), populations overrepresented at the lowest levels of health literacy (below basic level) in the United States include people over age 65, those who did not graduate from high school, persons who did not speak English before starting school, people who have poor health status, those who are of racial and ethnic minority groups, and individuals without medical insurance.4

An increasing number of efforts are ongoing across the United States and internationally to address health literacy. Significant national initiatives include Healthy People 2010,5 the Joint Commission’s report “Improving Health Literacy to Protect Patient Safety,”6 and the U.S. Department of Heath and Human Services Office of the Surgeon General’s “Workshop on Improving Health Literacy.”7 Other organizations attempting to address health literacy include the American Medical Association8 and the Partnership for Clear Health Communication.9 Many organizations are launching successful health literacy–based interventions such as the Canyon Ranch Institute’s Life Enhancement Program, an integrated approach to prevention and wellness.10 Additionally, there are a growing number of curricula addressing health literacy being developed by a wide range of organizations and individuals.11 Equally significant efforts are ongoing in a number of countries around the world, particularly Canada,12Australia,13 and Switzerland.14

The purposes of this article are to familiarize readers with the concept of health literacy; demonstrate how health literacy can serve as a tool to improve the public’s understanding of Alzheimer’s disease (AD), the seventh leading cause of death; and suggest generally applicable strategies for clinicians.

Concept of Health Literacy

Health literacy is a relatively new term most commonly defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”15Unfortunately, health literacy has at times been construed as having different meanings in various contexts. The earliest definitions focused only on the inabilities of individuals to read and understand information in the healthcare system. However, an international consensus is beginning to emerge to define health literacy as a wide range of skills and abilities, reflecting the extent to which people are able to find, understand, evaluate, communicate, and use health information and concepts to make informed choices, reduce health risks, reduce inequities in healthcare, and increase quality of life in a variety of settings across the life course.16-18 This leads to a robust conceptual framework of health literacy that is characterized by four central domains: (1) fundamental literacy; (2) science literacy; (3) civic literacy; and (4) cultural literacy.2

Fundamental literacy refers to the skills and strategies involved in reading, speaking, writing, and interpreting numbers (numeracy). Science literacy refers to levels of competence with science and technology, including some awareness of the process of science.

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