Sarah Goodwin

Kathi Ovnic
Holly Korschun
February 11, 1998


One out of three senior citizens does not have the health literacy skills necessary to understand instructions for prescriptions, medical forms and doctors' directions on self-care, according to a new study published Feb. 9 in the Journal of the American Medical Association (JAMA).

The study was conducted by the Prudential Center for Health Care Research in collaboration with Emory University and Case-Western Reserve University. The investigators interviewed more than 3,000 Medicare enrollees over the age of 65 who were enrolled in four Prudential HealthCare plans in Cleveland, Houston, Miami and Tampa.

The new study is the first ever to review levels of health literacy among Medicare enrollees in a national managed care organization. The patient survey included tests to determine the patients' ability to understand prescription instructions, blood sugar self-monitoring guidelines, instructions for preparing for diagnostic tests, and understanding a standard Medicaid document.

More than one-third of study participants whose primary language is English had low health literacy, while 54% of the Spanish-speaking participants had low health literacy, even though testing was done in the seniors' native language. Low health literacy overall ranged from 16% of those ages 65-69 to 58% for those above age 85.

Ruth Parker, M.D., Emory University associate professor of medicine, and Mark Williams, M.D., Emory associate professor of emergency medicine, were co-authors of the study. Drs. Parker and Williams have conducted previous studies of public hospital patients at Atlanta's inner-city Grady Memorial Hospital. These studies have demonstrated that patients with low health literacy are less likely to understand their discharge diagnosis, reasons for taking medications, plans for follow-up tests and appointments, and elements of self-care. Patients with low health literacy are also hospitalized at a higher rate, according to Dr. Parker.

"Health literacy is not necessarily related to a person's educational level or to their general ability to read," explains Dr. Parker, "and may be considerably worse than a person's general literacy. Even if an individual can read and understand materials with familiar content, he or she may still have difficulty comprehending materials that contain unfamiliar vocabulary and concepts."

In a related article also published in JAMA, the American Medical Association's Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs reviewed 216 articles in the medical literature dealing with health literacy. The committee concluded that "limited patient literacy is a barrier to effective medical diagnosis and treatment." Patients with inadequate functional health literacy were much more likely to report poor health status and also may have higher health care costs. Dr. Parker is chair and Dr. Williams is assistant chair of the AMA's Ad Hoc Committee.

The committee's recommendations, which have been adopted as AMA policy, include increasing professional and public awareness of the health literacy issue, beginning with education of medical students and physicians, improving patient-physician communication skills, and sponsoring research that would evaluate optimal methods of improving health literacy.

The Prudential Center for Health Care Research is using study findings to explore potential interventions, such as provider training, alternative educational aids and changes in health care support services. Meanwhile, the following tips may help seniors better understand the health care information they receive:

1. Identify important questions about your condition or your treatment before visiting your doctor. Write them down or have a friend or family member write them down and take the list with you.

2. Make sure all your questions are answered during your visit. Write down the answers or have the doctor write them down so that a friend or family member can help you when you get home.

3. Repeat answers back to the doctor or nurse, to make sure that you understood them correctly.

4. If you have difficulty understanding what your doctor says to you, have a friend or family member go with you to your appointment.

5. Find out who you should call if you have questions later on, and keep this name and number near your phone. Ask a friend or family member to call if you don't understand the answer to your question.

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