ADRESSING HEALTH

LITERACY THROUGH
THE USE OF
TECHNOLOGY Brittny Bol
Maria Lira
Health Science 660D
June 15, 2018
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Table of Contents

Abstract………………………………………………………………………… Page 2

I. Executive Summary…………………………………………………………. Page 3

A. Background/Problem……………………………………………….. Page 3

B. Recommendations for action……………………………………….. Page 3

II. Context and importance of the problem……………………………………. Page 4

A. The problem……………………………………………………….. Page 4

B. Root causes for the problem…………………………………...….. Page 6

C. Policy implications of the problem and policy relevance………… Page 6

III. Critique of Policy Options………………………………………………... Page 7

A. Policy options in focus……………………………………...……. Page 7

B. This current approach is failing…………………………………... Page 8

IV. Policy Recommendations………………………………………………… Page 8

A. Steps needed to be implemented…………………………………... Page 8

B. Importance of action………………………………………………. Page 9

V. References………………………………………………………………… Page 10
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Abstract

Our nation has had a health literacy problem for more than 15 years. This issue can only be

understood using that exact data from back in 2003 which is clearly unacceptable. Health literacy

is affecting the United States population as a whole and it is also continuously still being a

burden all rooting from the same problem. Technology evolves very quickly and many agencies

are currently using this and technology itself as an advantage to provide the most effective health

care services to the patients they serve. Policy makers as one of the most important and influent

stakeholders hold the capacity to see make the change through funding and also taking advantage

of technology to address this highly concerning and continuous issue in our nation. This nation

has and will continue to suffer if no policy actions are taken, and the sooner they are addressed

the sooner our nation can overcome this barrier.

Keywords: health literacy, health literacy technology

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I. EXECUTIVE SUMMARY

A. Background/ Problem:

As a national standard set by Healthy People 2020, health literacy is a social determinant

of health that is affecting our nation (NACIHL, n.d.). Health literacy has always been a problem

for our nation and in today’s day we are focusing more on how this issue can be addressed and

what actions can be taken to provide the most effective and proactive action to make it a

permanent solution. The only data available that provides a depiction of this problem at large

came from the National Assessment of Adult Literacy which found that 53 percent of Americans

were intermediate in health literacy; this means that only about half of the nation is able to read

instructions on a medical label and follow them (HHS, 2003). The quote “all adults, regardless of

their health literacy skills, were more likely to get health information from radio/television,

friends/family, and health professionals than from print media” clearly shows that technology is

clearly making an impact on the populations who seek it (HHS, 2003).

B. Recommendations for Action:

Lack of updated information in regards to health literacy research is one policy change

recommendation for the provision of more accurate and updated information. An issue cannot

be solved if there are not adequate and accurate timely facts provided to address that issue.

Policies that address the provision of funding for agencies that are currently implementing

technology in a form that helps address or decrease health literacy would be another

recommendation. The increase in funding for agencies such as non-profits can provide the

research needed to evaluate the implementations of technology they are currently using and

whether it is creating a positive change in our nation’s health literacy issue.

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III. CONTEXT AND IMPORTANCE OF THE PROBELM

A. The problem:

According to the CDC, health literacy is defined as, “the capacity to obtain, process and

understand basic health information and services needed to make appropriate health decisions”.

The current problem is that 77 million adults in the United States would have difficulty with

common health tasks, such as following directions on a prescription drug label or adhering to a

childhood immunization schedule using a standard chart (NACIHL, n.d.). In 2003 the National

Assessment of Adult Literacy (NAAL) was conducted to measure adult health literacy in the

United States and it divided health literacy levels into four categories; proficient, intermediate,

basic, and below basic. To score at intermediate health literacy levels it means that a person can

“read instructions on a prescription label, and determine what time a person can take the

medication”, therefore those 77 million adults not scoring a proficient level of health literacy

would have difficulty with as previously mentioned common health tasks (NACIHL, n.d.).

It is important to note that even people with strong literacy skills can face health literacy

challenges. Some ways that health literacy can be a challenge for people is when people are not

familiar with medical terms or how their bodies work, when they have to interpret numbers and

make a health care decision, or when they are diagnosed with a serious illness and are scared or

confused (NACIHL, n.d.). Health literacy affects how people can navigate the healthcare system

such as filling out complex forms and locating providers and services (“Health Literacy - Fact

Sheet: Health Literacy Basics,” n.d.). If a person has a chronic illness and they do not know how

to locate the services that they need or fill a prescription, then they cannot make well informed

health decisions. Health literacy also affects how people manage their chronic conditions
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because they may not understand their illness and the need to adhere to medication or other self-

care management.

Limited health literacy affects adults in all racial and ethnic groups, ranging from 28

percent white adults to 65 percent Hispanic adults (“National Action Plan to Improve Health

Literacy - health.gov,” n.d.). According to the National Network of Libraries, the United States

Department of Health and Human Services recognizes that “culture affects how people

communicate, understand and respond to health information” (NNLM, 2018). Therefore, there is

a cultural competency component that needs to be addressed when addressing health literacy in

the United States. There are also individuals with limited English proficiency (LEP) and they

experience not only a health literacy barrier, but also a language barrier when it comes to

communicating about health information and services (“Health Literacy - Fact Sheet: Health

Literacy Basics,” n.d.).

The problem with low health literacy is that people start turning to technology to find the

answers that they may be looking for about matters that affect their health. According to the

NAAL report of 2003, “higher percentages of adults with below basic or basic health literacy

than adults with intermediate health literacy received a lot of information about health issues

from radio or television”. The problem with this is that because of lack of understanding about

medical terminology the person listening to these sources may not fully understand what the

radio or television is discussing. The NAAL also found that all adults no matter what health

literacy level obtained health information from family or friends, radio or television or their

health care provider rather than printed media (NAAL, 2003). This could be due to the fact that

people with low health literacy might not always know how to address their health concerns with

their physician and seek the use of technology through radio or television rather than printed
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media. As the CDC states, “low health literacy is a threat to the health and wellbeing of

Americans”. The need for improvement in health literacy means that as a nation this is a

problem we must solve.

B. Root causes of the problem:

The root cause of the health literacy is that health information is not easily accessed because

of the way that it is designed, delivered, or distributed, and people do not have the skills to

understand health information that is presented to them. According to the NAAL, even high

school and college graduates can have limited health literacy (HHS, 2000). This shows that the

level of education is not the problem, it is the way that health information is presented. A study

looked at patient education material available on the internet and found that many of it was

written at high school or college reading levels, and the average United States resident reads at

8th grade or below reading level (Stossel, Segar, Gliatto, Fallar, & Karani, 2012). This example

shows how health information is now well designed and is contributing to the health literacy

problem in America yet not considering if individuals have a language barrier. As previously

mentioned, cultural competence and linguistics is also an impactful factor for health literacy and

again being another root cause. This is an example of how health information is not distributed

as appropriately as it should be.

C. Policy implications of the problem and policy relevance:

As with any other health or health care issue, financial burdens almost always play

enough of a role for changes to be implemented. According to the presented report on “Low

Health Literacy: Implications for National Health Policy” the cost for low literacy to the United

States economy is that of $106 to $ 238 billion annually, which represents between 7 percent and

17 percent of all personal health care expenditures (NNLM, 2018). The reason for this financial
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burden can come from patients not understanding discharge instruction after leaving the hospital,

using the emergency room instead of urgent care or primary doctor, or even from having to go to

the emergency room because they did not adhere to their medication and needed emergency

intervention. All of these situations can be alleviated if there was better health communication

and health literacy among Americans all across the nation.

This financial burden to the United States could also be alleviated if there was funding

provided to research. As stated before, in 2003 the National Assessment of Adult Literacy was

conducted, and it provided the initial data about health literacy in the United States. Currently, 15

years have passes since this assessment was conducted and we need to know where Americans

are today when it comes to health literacy. Research can provide the information needed to once

again address the issue of health literacy in our nation, evaluate what is currently being done, and

most importantly how it can be changed to be the most effective and less costly change for our

nation.

IV. CRITIQUE OF POLICY OPTIONS:

A. Policy options in focus

One way that health literacy is being addressed at different organizations such as Kaiser

Permanente, is through the 24/7 nurse helplines or their creation of phone applications (Kaiser,

2018). These new innovative forms help their patients to be able to have the extra time they need

if they have questions in regards towards their health for which they might not have had during

the in-person appointment with their primary care provider. This also might help reduce the use

of unreliable internet websites that the public uses to find health or illness information that can

be misleading and incorrect. It is already a concerning problem that people might not fully
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understand medical terminology or how to properly take their medications and having the

addition of incorrect information only increases the problem.

B. This current approach is failing

The reason why this current approach is failing is because it is not addressing the root cause

of health literacy. As stated before, the root cause of health literacy is from health information

not being easily accessed because of the way that it is designed, delivered, or distributed. A 24/7

nurse helpline only addresses the root cause of how health information is distributed. Patients do

have a place to call and get accurate health information, but that does not mean that they now

how to fully understand the scope of their illness or how to manage and self-care their chronic

conditions. The problem with this approach is that people who do not have health literacy may

not know about this service that their health care providers have, or they may not know what it is

for, therefore may not take advantage of this resource. There is much policy work that can be

done surrounding health literacy, and below recommendations are provided.

V. POLICY RECOMMENDATIONS:

A. Steps needed to be implemented

Addressing health literacy in the United States is needed due to the burden of costs and

health outcomes of individuals. The recommendations found below are from the National Action

Plan to Improve Health Literacy from the U.S. Department of Health and Human Services,

Office of Disease Prevention and Health Promotion (NACIHL, n.d.).

1. Develop and disseminate health and safety information that is accurate, accessible, and

actionable.

2. Promote changes in the healthcare system that improve health information,

communication, informed decision-making, and access to health services.

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3. Incorporate accurate, standards-based, and developmentally appropriate health and

science information and curricula in child care and education through the university level.

4. Support and expand local efforts to provide adult education, English language instruction,

and culturally and linguistically appropriate health information services in the

community.

5. Build partnerships, develop guidance, and change policies.

6. Increase basic research and the development, implementation, and evaluation of practices

and interventions to improve health literacy.

7. Increase the dissemination and use of evidence-based health literacy practices and

interventions.

B. Importance of action:

It can be clearly understood that 15 years ago and to this day health literacy issues

continue to be too large of a burden for our nation to carry. Our nation’s policy makers need to

see how much of a negative effect this issue is costing not only in monetary form but more

importantly the health of our populations in every form we choose to see it. Technology use is

one of the most evolving, quickest and maybe even economic forms that we can help address our

nation’s health literacy issue. The sooner funding for the above recommendations is provided,

the sooner action can be taken hence providing our nation with higher literacy levels in hopes of

giving them the best chance towards a better future.

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References:

Centers for Disease Control and Prevention. (2018). Understanding Literacy & Numeracy |

Health Literacy | CDC. Retrieved June 11, 2018, from

https://www.cdc.gov/healthliteracy/learn/UnderstandingLiteracy.html

Health Literacy - Fact Sheet: Health Literacy Basics. (2000). Retrieved June 11, 2018, from

https://health.gov/communication/literacy/quickguide/factsbasic.htm

Kaiser Permanente. (2014). Urgent Care | Kaiser Permanente. Retrieved June 11, 2018, from

https://thrive.kaiserpermanente.org/care-near-you/southern-california/urgent-care/

Koh, H. K., Berwick, D. M., Clancy, C. M., Baur, C., Brach, C., Harris, L. M., & Zerhusen, E.

G. (2012). New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation

Move Beyond The Cycle Of Costly “Crisis Care.” Health Affairs, 31(2), 434–443.

https://doi.org/10.1377/hlthaff.2011.1169

National Action Plan to Improve Health Literacy - health.gov. (n.d.). Retrieved June 9, 2018,

from https://health.gov/communication/initiatives/health-literacy-action-plan.asp

Schillinger, D. (2002). Association of Health Literacy With Diabetes Outcomes. JAMA, 288(4),

475. https://doi.org/10.1001/jama.288.4.475

Stossel, L. M., Segar, N., Gliatto, P., Fallar, R., & Karani, R. (2012). Readability of Patient

Education Materials Available at the Point of Care. Journal of General Internal

Medicine, 27(9), 1165–1170. https://doi.org/10.1007/s11606-012-2046-0