Patient Literacy and Nursing Education In today’s complex healthcare environment, literacy is increasingly becoming a crucial determinant of patient outcomes and overall public health. Health literacy, which encompasses the ability to read, understand, and act on healthcare information, has gained significant attention, particularly as healthcare providers strive to enhance patient engagement and empowerment. For nurses, one of the key roles in patient care is to ensure that individuals, especially those with lower literacy skills, are adequately informed about their health, treatment options, and self-care practices. This article delves into the issue of health literacy within nursing education, exploring its historical context in America, its impact on the healthcare system, the nurse’s role in patient education, and the goals surrounding patient literacy.
Literacy in the Adult Patient: An American Historical Perspective
Over the past several decades, literacy, particularly adult literacy, has been a focal point for educators, government officials, and healthcare providers. Adult illiteracy has been a persistent problem in the United States, despite numerous efforts aimed at curbing it through testing, literacy programs, and governmental initiatives. According to data, many individuals in the U.S. lack the basic literacy skills necessary to navigate everyday tasks, such as completing job applications, interpreting forms, or even understanding medication instructions (Rampey et al., 2016).
Historically, one of the major turning points in addressing adult literacy came in the 1980s, when President Ronald Reagan initiated the National Adult Literacy Initiative. This was followed by the United Nations’ declaration of 1990 as International Literacy Year (Belton, 1991; Wallerstein, 1992). In 1992, the U.S. Department of Education conducted the National Adult Literacy Survey (NALS), revealing a startling number of adults who were functionally illiterate or marginally literate. The findings spurred a series of initiatives aimed at improving literacy rates (Weiss, 2003; Weiss et al., 2005).
The rise of literacy programs such as Literacy Volunteers of America and Laubach Literacy International, which merged to form ProLiteracy in 2002, has helped to bolster efforts to improve literacy skills both in the U.S. and globally. ProLiteracy is now the largest adult literacy organization in the world, serving 1,000 literacy programs in the U.S. and 20 developing countries (ProLiteracy, 2017).
Patient Literacy and the Healthcare System
The intersection of literacy and healthcare has garnered increased attention over the past 15 years. As healthcare becomes more complex, it is evident that patients who struggle with basic literacy also face challenges in understanding health information, navigating the healthcare system, and making informed decisions about their care. This phenomenon, known as health literacy, refers to a person’s ability to read, understand, and apply health information in a way that allows them to make appropriate decisions about their health (Friedman & Hoffman-Goetz, 2008).
Limited health literacy has become one of the key public health concerns in the United States. Reports such as Healthy People 2010 and Healthy People 2020 have highlighted the need for improvements in health literacy across all populations (USDHHS, 2000, 2014). In 2010, the National Action Plan to Improve Health Literacy (NAP) was developed as a collaborative effort between several agencies within the U.S. Department of Health and Human Services (USDHHS, 2010). The NAP identified a series of strategic actions aimed at improving health literacy, particularly among vulnerable populations.
The health literacy problem is far-reaching and multifaceted. Research has demonstrated that individuals with limited health literacy are more likely to experience poor health outcomes, higher healthcare costs, and increased rates of hospitalization (Paasche-Orlow & Wolf, 2007a; Wu et al., 2016). Limited health literacy can also contribute to difficulties in managing chronic diseases, understanding medication instructions, and adhering to treatment regimens (Pignone et al., 2005).
The Nurse’s Role in Empowering Patients through Education
Nurses are uniquely positioned to address health literacy challenges because of their direct and ongoing contact with patients. As advocates for patient education, nurses can empower individuals to make informed decisions about their health by providing clear, accessible, and actionable information. According to the National Action Plan (USDHHS, 2010), there are three overarching goals in improving health literacy:
- Providing access to accurate and actionable health information.
- Delivering person-centered health information and services.
- Supporting lifelong learning and skills development for promoting health.
Nurses, in particular, play a critical role in all three areas. Whether in a hospital, community clinic, or home health setting, nurses are often responsible for explaining complex medical information to patients in a way that is easily understandable and culturally sensitive. This patient-centered approach is critical for improving health literacy and promoting better health outcomes.
Furthermore, the NAP outlines seven goals aimed at improving health literacy across all sectors of healthcare:
- Develop and disseminate health and safety information that is accurate, accessible, and actionable.
- Promote changes in the healthcare system to improve health information, communication, and decision-making.
- Incorporate standards-based health information into education systems.
- Support community-based adult education programs.
- Build partnerships to guide health literacy initiatives.
- Increase research into effective health literacy interventions.
- Expand the dissemination of evidence-based health literacy practices (USDHHS, 2010).
Goals Regarding Patient Literacy
Improving patient literacy requires collaboration across a variety of sectors, including healthcare, education, and community organizations. While nurses play a crucial role in educating patients, achieving the goals set forth by the NAP requires coordinated efforts to ensure that all patients, regardless of their literacy levels, can access the healthcare information and services they need.
One of the key challenges in addressing health literacy is that many patients may not openly disclose their difficulties with reading or understanding medical information. As a result, healthcare providers must be proactive in assessing literacy levels and tailoring educational materials to meet patients’ needs. Nurses, in particular, must be sensitive to the cultural, educational, and socioeconomic factors that may affect patients’ understanding of health information (Wong, 2012).
Research has shown that individuals with lower literacy levels are more likely to experience adverse health outcomes, including higher rates of hospitalization, increased healthcare costs, and greater difficulty managing chronic conditions (Baker et al., 1999; Parnell, 2014). These findings highlight the importance of addressing health literacy as a means of improving not only individual patient outcomes but also the efficiency and effectiveness of the healthcare system as a whole.
The Importance of Clear Communication in Health Education
Traditionally, healthcare professionals have relied heavily on printed educational materials (PEMs) to convey important health information. However, research has shown that many of these materials are written at a reading level that exceeds the average literacy skills of patients, particularly those with lower levels of education or who are non-native English speakers (Ache, 2009). Kessels (2003) found that 40% to 80% of medical information provided by healthcare professionals is forgotten almost immediately, and about half of the information that patients do remember is recalled incorrectly.
This has serious implications for patient safety and the ability of individuals to follow through on treatment recommendations. When educational materials are not written in a clear and accessible way, patients are less likely to fully understand their medical conditions or the steps they need to take to manage their health. This can result in poor health outcomes, decreased adherence to treatment regimens, and an increased burden on the healthcare system (Parnell, 2014).
For nurses, the challenge is to create educational materials and communication strategies that meet patients where they are in terms of literacy and comprehension. This may involve using simpler language, incorporating visual aids, and offering opportunities for patients to ask questions and engage in dialogue about their care. Additionally, healthcare providers must recognize the importance of assessing a patient’s literacy level as part of the overall health assessment process (Quirk, 2000).
Conclusion
Health literacy remains a critical challenge within the U.S. healthcare system, but it is also an area where nurses can have a profound impact. By focusing on clear communication, patient education, and culturally sensitive care, nurses can help bridge the gap between patients and the often complex medical information they need to understand in order to make informed decisions. Improving patient literacy is not only essential for individual patient outcomes, but it also has the potential to reduce healthcare costs and improve the overall quality of care. As healthcare continues to evolve, the role of nurses in educating and empowering patients will remain central to improving health literacy across the population.