“Health Literacy” refers to the degree to which a person obtains, thinks through and understands basic health information and services needed to make appropriate decisions. It is influenced by how medical personnel share information with patients and also how families communicate their needs and questions. It also is dependent on one’s knowledge about the health topic and cultural background. Basically, being health literate translates to being able to fully engaged in one’s healthcare–navigating the system, adequately sharing concerns and health history, understanding how to engage in self-care behaviors even when it comes to chronic care management, and lastly understand mathematical concepts like risk and probability. Persons with low health literacy can feel overwhelmed or may have erroneous information or limited understanding to make informed decisions. Ultimately all decisions affect one’s health.
It is important not to assume health literacy increases with educational attainment. If you have heard the terms “medical speak” or “lawyer speak”, if you do not have a working knowledge of the “vocabulary” you can quickly find yourself feeling lost…or maybe you are like me and had the experience of going to the mechanic for a “simple fix” or tune up that turned into a laundry list of issues you cannot verify or understand. Often, the only choice was to approve the work and trust that the work was needed.
Our group just Published a study that examined parental health literacy and associations to common pediatric health risks. Some of the behaviors included injury prevention behaviors, first-aid knowledge, secondhand smoke exposure, and TV viewing. We also made sure to take into account the child’s gender, race/ethnicity, insurance status, age, parent’s language preference (English or Spanish) and whether a parent reported depressive symptoms.
What we found was interesting. Lower health literacy was more likely among parents with depression. Others have found this too. However, we also found parents with lower health literacy also had a lower likelihood of engaging in injury prevention behavior (for example, not securing firearms, not having a working smoke detector, lack of first aid knowledge) and also allowing children to watch greater than 2 hours of TV a day.
So what can we do about this? Pediatric offices should be sensitive to this and start screening parents for low health literacy? This can be done with a Single question, “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?” Responses are: Never, rarely, sometimes, often or always. Answers of sometimes to always indicates some challenges with reading printed health material. Knowing that a parent may have some difficulty, medical providers can break down concepts by using simple language with no medical jargon, write down instructions using easy to understand words, and ask parents to repeat back instructions to ensure understanding.
Parents/Patients can be encouraged to write down and ask any questions.
- Bring all medications to doctor’s appointments
- Create a binder of health information for each family member and bring to all medical and therapy appointments. Put all discharge instructions, growth charts , visit summaries. For kids, you can even include report cards, Individualized Education Plans (IEPs) or sample work–especially if you are worried about how your child is learning or behaving in school.
Another set of questions I like to coach parents to have in mind when in the doctor’s or therapist’s office:
- What is my (my child’s) main problem?
What do I need to do?
Why is it important for me to do this (for my child)?
(Courtesy of the National Patient Safety Foundation)
Remember, no question is never a bad question. Make sure you know and understand everything that was discussed…including your options and especially if medications are part of the discussion. You want to know: why is the medication being prescribed? what is the name and dose? What can I expect? What should I look out for? How long will the medication be needed? Who do I call if I have questions or want to discuss potential side effects?
Communication is the key and walking out of the doctor’s office should leave you feeling like a partner in your or your child’s care. If you feel overwhelmed or do not understand something…please do not hesitate to say something. Your doctor/therapist should always want to ensure you understand everything related to your or your child’s health!
For more information about our study, see this great blog post by Dr. Furman: Health Literacy and Pediatric Care-What’s a Doctor to Do?