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How health care systems can begin to address the challenge of limited literacy

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Conclusion

The growing literacy and health literature calls attention to the ways in which the U.S. health care system is inadequate and even unjust, not only for the estimated 90 million U.S. adults with limited literacy, but for many other users to the system. We have presented 3 overarching principles for health system transformation that focus on promoting productive interactions between patients and providers, reorganizing health care delivery, and embracing a community level and ecological perspective. We believe that instituting such changes could improve the quality of care not only for patients with limited literacy, but for all health care consumers, and could contribute to the development of a more “health literate” society.

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References

  1. DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004;19:1228–39.

    Article  PubMed  Google Scholar 

  2. Understanding and promoting health literacy (R01) PAR-04-116. Available at: http://grants2.nih.gov/grants/guide/pa-files/PAR-04-116.html. Accessed April 7, 2005.

  3. Ratzan SC, Parker RM. Introduction. In: Selden CR, Zorn M, Ratzan SC, Parker RM, eds. National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Available at: http://www.nlm.nih.gov/pubs/cbm/hliteracy.html. Accessed May 9, 2006. Vol. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services; 2000.

    Google Scholar 

  4. Fang MC, Machtinger EL, Wang F, Schillinger D. Health literacy and anticoagulation-related outcomes among patients taking warfarin. J Gen Intern Med. 2006;21:841–6.

    Article  PubMed  Google Scholar 

  5. Adams K, Corrigan JM. Institute of Medicine. Priority Areas for National Action: Transforming Health Care Quality. Committee on Identifying Priority Areas for Quality Improvement. Washington, DC: National Academies Press; 2003.

    Google Scholar 

  6. Improving chronic illness care: A National Program of the Robert Wood Johnson Foundation. Available at: http://www.improvingchroniccare.org/. Accessed May 9, 2006.

  7. Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4.

    PubMed  CAS  Google Scholar 

  8. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20:64–78.

    Article  CAS  Google Scholar 

  9. Improving patient safety through informed consent for patients with limited health literacy: an implementation report. National Quality Forum. Available at: http://www.qualityforum.org/docs/informed_consent/webinformedconsentMember+public09-13-05.pdf. Accessed May 9, 2006.

  10. Sudore RL, Landefeld CS, Williams B, Barnes D, Lindquist KS, Schillinger D. Use of a modified informed consent process among vulnerable patients: a descriptive study. J Gen Intern Med. 2006;21:867–73.

    Article  PubMed  Google Scholar 

  11. Schillinger D, Bindman A, Wang F, Stewart A, Piette J. Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns. 2004;52:315–23.

    Article  PubMed  Google Scholar 

  12. Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. J Acquir Immune Defic Syndr. 2000;25:337–44.

    Article  PubMed  CAS  Google Scholar 

  13. Mancuso CA, Rincon M. Asthma patients’ assessments of health care and medical decision making: the role of health literacy. J Asthma. 2006;43:41–4.

    Article  PubMed  Google Scholar 

  14. Bass PF, Wilson JF, Griffith CH, Barnett DR. Residents’ ability to identify patients with poor literacy skills. Acad Med. 2002;77:1039–41.

    Article  PubMed  Google Scholar 

  15. Lindau ST, Tomori C, Lyons T, Langseth L, Bennett CL, Garcia P. The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women. Am J Obstet Gynecol. 2002;186:938–43.

    Article  PubMed  Google Scholar 

  16. Seligman H, Wang F, Palacios J, Wilson C, Daher C, Schillinger D. Physician notification of their diabetes patients with limited health literacy: a randomized, controlled trial. J Gen Intern Med. 2005;20:1001–7.

    Article  PubMed  Google Scholar 

  17. Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006;61:173–90.

    Article  PubMed  Google Scholar 

  18. Wofford JL, Smith ED, Miller DP. The multimedia computer for office-based patient education: a systematic review. Patient Educ Couns. 2005;59:148–57.

    Article  PubMed  Google Scholar 

  19. Krishna S, Balas EA, Boren SA, Maglaveras N. Patient acceptance of educational voice messages: a review of controlled clinical studies. Methods Inf Med. 2002;41:360–9.

    PubMed  CAS  Google Scholar 

  20. O’Connor AM, Stacey D, Rovner D, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2001; CD0001431.

  21. Lewis D. Computer-based approaches to patient education: a review of the literature. J Am Med Inform Assoc. 1999;6:272–82.

    PubMed  CAS  Google Scholar 

  22. Friedman RH, Stollerman J, Rozenblyum L, et al. A telecommunications system to manage patients with chronic disease. Medinfo. 1998;9:1330–4.

    PubMed  Google Scholar 

  23. Bickmore T, Giorgino T. Health dialog systems for patients and consumers. J Biomed Inform. 2006 (in press).

  24. Wagner EH, Bennett SM, Austin BT, Greene SM, Schaefer JK, Vonkorff M. Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med. 2005;11(suppl 1):S7-S15.

    PubMed  Google Scholar 

  25. DeWalt DA, Pignone M, Malone R, et al. Development and pilot testing of a disease management program for low literacy patients with heart failure. Patient Educ Couns. 2004;55:78–86.

    Article  PubMed  Google Scholar 

  26. Rothman R, Malone R, Bryant B, Horlen C, DeWalt D, Pignone M. The relationship between literacy and glycemic control in a diabetes disease-management program. Diabetes Educ. 2004;30:263–73.

    PubMed  Google Scholar 

  27. Davis TC, Wolf MS, Bass, PF III, et al. Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med. 2006;21:847–51.

    Article  PubMed  Google Scholar 

  28. Parker RM, Kindig DA. Beyond the IOM health literacy report: are the recommendations being taken seriously? J Gen Intern Med. 2006;21:891–2.

    Article  PubMed  Google Scholar 

  29. O’Connor PJ, Desai J, Solberg LI, et al. Randomized trial of quality improvement intervention to improve diabetes care in primary care settings. Diabetes Care. 2005;28:1890–7.

    Article  PubMed  Google Scholar 

  30. Rosenthal MB, Frank RG, Li Z, Epstein AM. Early experience with payfor-performance: from concept to practice. JAMA. 2005;294:1788–93.

    Article  PubMed  CAS  Google Scholar 

  31. Rosenthal MB, Frank RG. What is the empirical basis for paying for quality in health care? Med Care Res Rev. 2006;63:135–57.

    Article  PubMed  Google Scholar 

  32. Casalino L, Gillies RR, Shortell SM, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA. 2003;289:434–41.

    Article  PubMed  Google Scholar 

  33. Castle NG, Brown J, Hepner KA, Hays RD. Review of the literature on survey instruments used to collect data on hospital patients’ perceptions of care. Health Serv Res. 2005;40:1996–2017.

    Article  PubMed  Google Scholar 

  34. Health Literacy and Patient Safety. Joint Commission on Accreditation of Healthcare Organizations. Available at: http://www.jointcommission.org/PublicPolicy/health_literacy.htm. Accessed May 9, 2006.

  35. Baker DW. Reading between the lines: deciphering the connections between literacy and health. J Gen Intern Med. 1999;14:315–7.

    Article  PubMed  CAS  Google Scholar 

  36. Pignone M, DeWalt D, Sheridan S, Berkman ND, Lohr KN. Interventions to improve health outcomes for patients with low literacy: a systematic review. J Gen Intern Med. 2005;20.

  37. Roter D. Health literacy and the patient-provider relationship. In: Schwartzberg JG, VanGeest JB, Wang CC, eds. Understanding Health Literacy: Implications for Medicine and Public Health. American Medical Association Press; 2005:87–100.

  38. Rudd RR, Renzulli D, Pereira A, Daltroy L. Literacy demands in health care settings: the patient perspective. In: Schwartzberg JG, VanGeest JB, Wang CC, eds. Understanding Health Literacy: Implications for Medicine and Public Health. American Medical Association Press; 2005:69–84.

  39. Schillinger D, Chen AH. Literacy and language: disentangling measures of access, utilization, and quality. J Gen Intern Med. 2004;19:288–90.

    Article  PubMed  Google Scholar 

  40. Rootman I, Ronson B. Literacy and health research in Canada: where have we been and where should we go? Can J Public Health. 2005;96(suppl 2):S62-S77.

    PubMed  Google Scholar 

  41. Sentell TL, Halpin HA. Importance of adult literacy in understanding health disparities. J Gen Intern Med. 2006;21:862–6.

    Article  PubMed  Google Scholar 

  42. Weiss BD, Francis L, Senf JH, Heist K, Hargraves R. Literacy education as treatment for depression in patients with limited literacy and depression—a randomized controlled trial. J Gen Intern Med. 2006;21:823–8.

    Article  PubMed  Google Scholar 

  43. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15:259–67.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. UCSF Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA

    Dean Schillinger MD

  2. MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative, Seattle, WA, USA

    Sarah M. Greene MPH & Edward H. Wagner MD, MPH

  3. Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 91 East Concord Street, Suite-200, 02118, Boston, MA

    Michael K. Paasche-Orlow MD, MA, MPH

Authors
  1. Michael K. Paasche-Orlow MD, MA, MPH
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  2. Dean Schillinger MD
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  3. Sarah M. Greene MPH
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  4. Edward H. Wagner MD, MPH
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Corresponding author

Correspondence to Michael K. Paasche-Orlow MD, MA, MPH.

Additional information

None of the authors have any conflict of interest to declare.

Dr. Schillinger was supported by NIH Clinical Scientist Award K23RR16539-04.

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Paasche-Orlow, M.K., Schillinger, D., Greene, S.M. et al. How health care systems can begin to address the challenge of limited literacy. J GEN INTERN MED 21, 884–887 (2006). https://doi.org/10.1111/j.1525-1497.2006.00544.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00544.x

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