October marks Health Literacy Month, a crucial observance dedicated to highlighting the essential role health literacy plays in patient care, especially within hospital medicine. Health literacy—the ability of patients to obtain, understand, and use healthcare information—directly impacts clinical outcomes, patient satisfaction, and overall healthcare efficiency. For hospitalists, recognizing and addressing health literacy barriers is not merely beneficial but imperative.
Research consistently underscores the gravity of health literacy. A study published in the Annals of Internal Medicine demonstrated that limited health literacy is associated with increased hospitalizations, greater use of emergency care, lower adherence to treatment regimens, and poorer overall health outcomes.1 Specifically, it noted that individuals with inadequate health literacy experience difficulty navigating complex healthcare systems, understanding prescription instructions, and comprehending discharge summaries.
In an American Journal of Medical Quality study, the authors reported that nearly half of hospitalized patients could not correctly explain their diagnosis or the necessary follow-up care after discharge, emphasizing the need for clearer patient-provider communication in hospital settings.2 Similarly, Kripalani S, et al. highlighted that nearly 40% of discharged patients misunderstood the medication instructions provided by their hospital, increasing the risk of medication errors and subsequent readmissions.3
Hospitalists can significantly mitigate these risks through focused interventions. A practical and effective approach is the “teachback” method, a communication technique whereby providers ask patients to repeat back the information conveyed in their own words. A randomized controlled trial conducted by Schillinger et al. revealed that the teach-back method significantly improved diabetic patients’ comprehension of insulin management, illustrating its efficacy in clinical practice.4
Another influential strategy involves enhancing the readability of written healthcare materials provided to patients. According to a review in Clinical Orthopaedics and Related Research, the average readability level of patient education materials is often higher than the recommended sixth-grade reading level, which can pose significant barriers. Their analysis showed that materials written at appropriate reading levels improved patient understanding, adherence, and satisfaction.5
Hospital discharge practices represent another critical area where literacy-sensitive strategies are essential. A randomized control trial published in the Annals of Internal Medicine demonstrated that through the Re-Engineered Discharge program, which incorporates literacy-sensitive education materials and structured follow-up plans, hospital readmission rates significantly decreased, and patients benefited greatly from clear, straightforward discharge summaries and explicit instructions.6
Additionally, digital health interventions, though promising, must consider health literacy. Bailey et al. reviewed digital health platforms and identified that complex language and navigation issues frequently limited patient engagement.7 Consequently, ensuring these platforms are user-friendly and accessible to diverse literacy levels is paramount for their success.
Cultural competence intersects critically with health literacy. A review by Shaw et al. emphasized that culturally tailored patient education materials significantly improved understanding and adherence among diverse populations.8 Hospitalists, therefore, must recognize the cultural context of literacy and implement education interventions sensitive to cultural backgrounds.
Hospital medicine programs that integrate health literacy training for clinicians yield positive outcomes. Green et al. described a successful program where hospitalists were educated about literacy-sensitive communication techniques. Post-training assessments indicated improved patient comprehension and satisfaction, affirming the value of continuous provider education on literacy awareness.9
In conclusion, health literacy is a determinant of patient safety, quality of care, and healthcare resource utilization. Hospitalists occupy a unique position to influence and improve patient outcomes significantly by addressing health literacy proactively. By adopting evidence-based approaches such as the teachback method, utilizing clear patient materials, enhancing discharge processes, and emphasizing cultural competence, hospitalists can make substantial progress in mitigating the adverse effects associated with limited health literacy.
Dr. Migliore
Dr. Migliore is an assistant professor of medicine at Columbia University College of Physicians and Surgeons, director of general medicine, perioperative and consult services, and medical director of surgery and surgical step-down at Columbia University Medical Center, all in New York.
For more information on health literacy, read Poor Patient Health Literacy and Its Impacts.
References
1. Berkman ND, et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107. doi: 10.7326/0003-4819-155-2-201107190-00005.
2. Coleman EA, et al. Understanding and execution of discharge instructions. Am J Med Qual. 2013;28(5):383-91. doi: 10.1177/1062860612472931.
3. Kripalani S, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1-10. doi: 10.7326/0003-4819-157-1-201207030-00003.
4. Schillinger D, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83-90. doi: 10.1001/archinte.163.1.83.
5. Badarudeen S, Sabharwal S. Assessing readability of patient education materials: current role in orthopaedics. Clin Orthop Relat Res. 2010;468(10):2572-80. doi:10.1007/s11999-010-1380-y.
6. Jack BW, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-87. doi: 10.7326/0003-4819-150-3-200902030-00007.
7. Bailey SC, et al. Literacy disparities in patient access and health-related use of internet and mobile technologies. Health Expect. 2015;18(6):3079-87. doi: 10.1111/hex.12294.
8. Shaw SJ, et al. The role of culture in health literacy and chronic disease screening and management. J Immigr Minor Health. 2009;11(6):460-7. doi: 10.1007/s10903-008-9135-5.
9. Green JA, et al. Addressing health literacy through clear health communication: a training program for internal medicine residents. Patient Educ Couns. 2014;95(1):76-82. doi: 10.1016/j.pec.2014.01.004.