Battling low health literacy one step at a time

Patients with low health literacy are at high risk of having poor health outcomes and experiences.

HealthLiteracy2Patients with low health literacy are at high risk of having poor health outcomes and experiences.Low health literacy exists in a large portion of the nation’s population. University of Alabama at Birmingham doctors and medical students are working to fix that.

In research on health literacy in the surgical population led by Daniel Chu, M.D., associate professor in the Division of Gastrointestinal Surgery, he and his team found that low health literacy is quite prevalent and exists across every socioeconomic class, race and geographic origin. Certain groups, however, are at even higher risk for having low health literacy, and this information will help develop more targeted interventions.

“African Americans with inflammatory bowel disease, for example, in Alabama and Mississippi have high rates of low health literacy and face incredible challenges managing a complicated disease that requires complicated management,” Chu said. “As providers and health care systems, we are responsible for helping these patients achieve the best possible outcomes and experiences. Health literacy is one way to take immediate action, and we are learning that the most impactful interventions occur at the provider and health care-system level.”

Chu, who also serves as associate director of Health Services Research, says what is important to highlight is that research has consistently linked health literacy with health outcomes. To be specific, patients with low health literacy are at high risk of having poor health outcomes and experiences. But this relationship is potentially modifiable in a positive direction.

“It is quite important to invest time and resources in addressing low health literacy because, if we can improve health outcomes and experiences, we benefit patients, providers and health care systems,” Chu said.

Why we are here

To help understand why there is such a low health literacy rate, Chu asked UAB School of Medicine students and residents to survey patients on their understanding of patient education materials that were provided to them.

One of those medical students, Elle Kaplan, was asked to study the readability of documents and how the layout of documents affects readability. She says one of the things that shocked her most was that a higher education level did not necessarily translate into higher health literacy. 

“If we can improve health outcomes and experiences, we benefit patients, providers and health care systems.”

“If people don’t have the capacity to understand, they won’t adhere to guidelines set for them,” Kaplan added. “As medical professionals, we can’t assume everyone knows what we’re talking about. This research has opened a Pandora’s box in many ways. Just because you are fluent in business or English doesn’t mean you have a high rate of health literacy.”

Kaplan says more image-based information — like infographics — were more widely understood, compared to a page filled with words and bullet points.

Samantha Baker, a third-year surgery resident at UAB, helped develop patient education materials for patients at the Birmingham VA Medical Center. She says her previous training in medical school prepared her to work with patients in Birmingham who had a similar level of health literacy.

“When I meet with patients, I say to them, ‘I know, when you leave here, you will want to tell your family members what we’ve talked about, so why don’t we practice? Tell me what you are going to say to them about our visit,’” Baker said. “I ask this so that I can know if we are on the same page and I can identify any gaps in their understanding.” 

The old adage “a picture is worth a thousand words” absolutely holds true, according to Chu.

HealthLiteracy4Daniel Chu, M.D., Division of Gastrointestinal SurgeryDiscovering collaborators

Chu also enlisted help from UAB School of Nursing Associate Professor Joy Deupree, Ph.D. Deupree, who serves as co-chair for the Alabama Health Literacy Initiative, has poured countless hours into understanding why states like Alabama have such poor health literacy rates.

In 2016, an executive order by Alabama Gov. Robert Bentley created the Health Literacy Partnership of Alabama; the work of the partnership concluded in February 2017 and produced a strategic plan to begin efforts to improve health literacy in the state.

She says patient anxiety can be a major contribution to low guideline adherence.

“What happens when you get in a car accident?” she said. “You have so much running through your head, it is hard to think. The same thing happens when you get a dire diagnosis — your head can get so cloudy that you can’t make clear decisions.”

She adds that there is a misconception about the face of health literacy. Many providers are adept at recognizing the population expected to have difficulty with health information — such as high school drop-outs, lower socioeconomic populations and those with English as a second language.

“In reality, the greatest demographic group of those at risk for low health literacy is our seniors. They have been out of school the longest and grew up at a time when medicine was much less complex,” she said.

With Deupree’s help, Chu and his team are hoping to make things easier for patients by simplifying information in easy-to-read formats.

“Our research with patients and focus groups has reiterated this and suggests that more visually based information could help patients better understand the surgical journey,” Chu said. “I think surgery is particularly amenable for this as we are a very visually based field.”

He adds that the goal of his current research is to convert text-heavy patient education material into image-heavy material using best practices in design and technology. He says he thinks image-based materials will lead to a better understanding of complex surgical information and,  hopefully, beneficial effects on patient outcomes and experiences.

Chu, Baker and general surgery resident Lauren Theiss, M.D., traveled to Montgomery, Alabama, in October to see Gov. Kay Ivey declare October 2019 as Health Literacy Month.