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Health Literacy: Comprehension Correlates to Good Health
Imagine yourself and your family in the middle of another country. Your child is ill and you need to find your way to
the hospital as quickly as possible. You studied the language in college and recognize many of the words, but it has
been years since youve used it and your comprehension is poor and your speaking ability worse still. Suddenly, you
find yourself in situation in which you are unable to satisfactorily convey your meaning. Details like symptoms, health
history, and medicine types, so easy to articulate at home, are greeted with blank looks and confusion. What do you
do?
Although many Americans find it difficult to understand and use information written A: The degree to which
at a competency level higher than the eighth grade, materials provided by health individuals have the capacity
to obtain, process and
care providers are, on average, written at grade levels 10 to 12. A National Adult
understand basic health
Literacy Survey in 1993 revealed that of the 90 million Americans who have difficulty
information and services
comprehending medical information, 47 percent have low or limited literacy skills. Of needed to make appropriate
these, 25 percent are immigrants from non-English-language backgrounds who often health decisions.
have to rely on interpreters to communicate. Research also shows that limited-English-
U.S. Department of
proficient (LEP) and minority populations are more likely than their white counterparts Health & Human Services
to have chronic disease, lack health insurance, and have difficulties communicating
with their health care providers1.
Even for those who speak English as a second language, comprehension of new vocabulary or subject matter can be
quite low. This is especially true when faced with difficult medical terminology. Add to this complicated grammar and
syntax, compound/complex sentences, use of idiomatic expressions and confusing or unfamiliar cultural references,
and real understanding can prove elusive indeed. As a result, comprehension suffers and the opportunities for
misinterpretation are greatly increased: a potentially dangerous scenario in many health care settings. The table
below, provided by the Center for Health Care Strategies (CHCS), compares the relative difficulty experienced in 2005
by four ethnic groups when communicating with their health care providers.
1
Center for Health Care Strategies, August 2005
In addition to an overall lower health status, those with low health literacy are less likely to take preventative health
measures, which can have disastrous consequences, especially during pandemics such as the current H1N1 outbreak.
According to the Journal of General Internal Medicine, patients with inadequate health literacy are twice as likely to be
hospitalized as those with adequate literacy (32% vs. 15%). Moreover, it is estimated that low health literacy results in
3 percent to 6 percent higher health care expenses, with federal and state health plans such as Medicare and Medicaid
financing the majority of this expense3.
Some Asian immigrant cultures, for example, are influenced less by science and more by traditional or Eastern views of
medicine. By contrast to Western models, these approaches tend to be more holistic and ritualistic, often incorporating
religious or animistic practices. Consider how one might view the cause(s) of an illness. Western medicine, informed
as it is by science, views illness as undesirable and demanding treatment. But among the Hmong culture the same
condition might be thought the result of evil spirits or the departing of ones own spirit from the body5.
Simply gathering information from a Hmong patient can be complicated by cultural differences. Among the Hmong,
saying no can actually be considered disrespectful, requiring health care communicators to avoid or rephrase yes-
or-no questions when creating medical forms or questionnaires targeted at this community. When distinctions of this
kind are added to the complex nature of most U.S. health care materials, complicated medical terms, and a dizzying
insurance system, it is little wonder that confusion and miscommunication are so common among LEP audiences.
2
Agency for Health Care Research and Quality, 2008
3
Center for Health Care Strategies, August 2005
4
USDOS, Bureau of Population, Refugees, and Migration, September 2006
5
Hmonghealthcare.org
Each text assessment results in a score based on the U.S. high school grade-level system (i.e., a data point on 8
means an eighth-grade student should be able to comprehend the material).
Similar to Fry, Flesch-Kincaid Grade Level is another tool to measure readability and can be found in your Microsoft Word
toolbar. It measures number of syllables per word and words per sentence. Heres an example of how it scores:
In conclusion, when developing health care outreach materials for LEP populations, it is crucial to keep health literacy
levels in mind. Developing a solid understanding of an audiences reading ability helps equip you to maximize the
effectiveness of your communications, fostering greater cultural understanding, increased patient involvement and,
ultimately, improved health.
About viaLanguage
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