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Health Literacy

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Strategies to improve health literacy for diverse populations should address literacy, language, and cultural barriers

Persons who find it difficult to obtain, process, and understand health information and navigate the health care system are considered to have limited health literacy. Racial and ethnic minority adults are more likely to have limited health literacy than white non-Hispanic adults. Several strategies have been developed to improve health literacy for individuals with limited health literacy, such as using simpler language and picture-driven media. However, materials should be relevant to the patient's language and culture as well.

Health literacy strategies must be integrated with those targeted to culturally diverse individuals and those with limited English proficiency (LEP), recommend Dennis P. Andrulis, Ph.D., M.P.H., of Drexel University School of Public Health, and Cindy Brach, M.P.P., of the Agency for Healthcare Research and Quality, in a recent paper.

For example, a patient's low score on a health literacy assessment could be due to low literacy, LEP, or lack of familiarity with Western health terms and concepts. Thus, clinicians need to integrate health literacy techniques, such as having patients explain back to the clinician what they have been told, with culturally competent communication practices, such as asking a patient what she thinks caused the illness and what type of treatment she thinks she should receive to reveal cultural barriers, use of folk medicine, or culturally dictated family involvement in medical decisions.

For clinicians to successfully overcome barriers related to literacy, language, and cultural vulnerabilities, health care organizations have to make corresponding changes in the delivery system. Leadership and senior management must be willing to invest in training, staffing, and physical plants to improve care for diverse patients with limited health literacy.

The authors present a vision for an integrated approach to health literacy and cultural and linguistic competence that illustrates the important roles that both clinicians and health care organizations play.

See "Integrating literacy, culture, and language to improve health care quality for diverse populations," by Drs. Andrulis and Brach, in the American Journal of Health Behavior 31(Suppl 1), pp. S122-S133, 2007. Reprints (AHRQ Publication No. 07-R079) are available from the AHRQ Publications Clearinghouse.

Editor's Note: October is Health Literacy Month. Low health literacy affects more than 90 million adults in the United States, and it limits a patient's ability to engage in, and benefit from, health care advances. Low health literacy is likely to be a major contributor of adverse health outcomes. Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases, less healthy behaviors, higher rates of hospitalizations, and overall poorer health.

AHRQ supports research that addresses health literacy as it pertains to prevention, healthy living, chronic disease management, patient-based health care, cultural competence, and health disparities. For more information about the Agency's efforts to promote health literacy go to

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