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Health Literacy: Strategies for Avoiding Communication Breakdown

Health Literacy: Strategies for Avoiding Communication Breakdown

At least half of all Americans are at risk for consequences resulting from low health literacy (HL).[1] These patients have poorer health outcomes and increased medical costs, and in some instances have experienced medical errors caused by communication breakdowns.[2–4] Efforts to mitigate the effects of low HL have been promoted by organizations including the Joint Commission[5] as well as via initiatives such as Healthy People 2010.[6] Patients with cancer are particularly vulnerable to the effects of low HL, owing to the complicated treatment regimens they receive. Oncology nurses can help by identifying patients who may be at risk and implementing strategies that can be used to help patients understand the information they receive.

HL is not simply the ability to read. Defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,”[6] HL requires the complex skills needed to combine reading with mathematical calculations, analytical skills, and decision-making capacity, then applying these skills to healthcare situations. In addition, patients need to be able to communicate their health concerns and describe their problems accurately to healthcare providers. Combining these patient tasks and responsibilities with the complexities of cancer treatment is a formula for communication breakdown.


Over the past decade, research has demonstrated the impact of low HL in the general population with alarming results. When compared to their counterparts, individuals with low HL have poorer health outcomes.[7] With less knowledge of their conditions and treatments and lower self-management skills,[3,8–11] these patients have higher use of emergency services[7] and higher rates of hospitalization.[12] In addition, individuals with low HL experience poor recall and comprehension of healthcare instructions.[13] Whether a result of this lack of understanding, lack of access, or other issues, low HL is associated with suboptimal cancer screening,[14,15] which can result in delayed or missed treatment.[16]

Who Is at Risk?

The significant impact of low HL on patient outcomes makes the need for intervention clear. Identifying patients at risk, however, remains a challenge. Contrary to popular opinion, low HL affects all segments of the population. In fact, highly literate, well-educated adults have reported difficulty understanding the information provided to them.[17] Someone with low HL cannot be identified by appearance, or even by knowing his or her educational or financial background.


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