Health Literacy:

An Introduction

Ann Rathbun, Ph.D.

Morehead State University
Morehead, Kentucky
 Is “More” actually “Less??”
 By partaking of the fleshy, usually
rounded, edible pomme fruit off a tree of
the rose family, one might potentially
maintain a distant relationship with ones
primary healthcare practitioner.
 The indefinite and continuous duration
regarded as that in which events succeed
one another acts to set right divisions of
tissue or ruptures of the integument or
mucous membrane, due to external
violence or some mechanical agency
rather than disease.
©Ann Rathbun, Ph.D.
 An Apple a day
keeps the doctor
away.

Time heals all wounds.

©Ann Rathbun, Ph.D.

 American Medical Association
Foundation
Health Literacy Toolkit

http://www.ama-assn.org/ama/pub/catego

©Ann Rathbun, Ph.D.

 What is health literacy?
 Health literacy is the ability of individuals
to read, understand, and act upon health-
related information. 
 Health literacy also refers to the capacity
of professionals and institutions to
communicate effectively so that
community members can make informed
decisions and take appropriate actions to
protect and promote their health. (NYC
Mayor’s Office of Adult Education)
©Ann Rathbun, Ph.D.
 What is health literacy?
 The ability to understand and use
health-related printed information in
daily activities at home, at work, and
in the community to achieve one's
goals and to develop one's
knowledge and potential.
NAAL, 2003

©Ann Rathbun, Ph.D.

 What is health literacy?
 Health literacy is the capacity to
obtain, process and understand basic
health information and services
needed to make appropriate health
decisions.
 (US Department of Health and Human Services, www.health.gov/
communication)

©Ann Rathbun, Ph.D.

 What is health literacy?
 “The ability to read and comprehend
basic concepts and tasks needed to
function sufficiently in the health
care system”

-U.S. Department of Adult

Education, Fact Sheet 20

©Ann Rathbun, Ph.D.

 Types of literacy
Can I search, comprehend and use information
found in these types of documents or forms???

 Prose Literacy
 The knowledge and skills needed to
perform tasks related to writing.
 Examples: writing such as
newspaper articles, editorials,
brochures ad instructional materials.

©Ann Rathbun, Ph.D.

 Types of literacy
Can I search, comprehend and use information
found in these types of documents or forms???

 Document Literacy
 The knowledge and skills needed to
perform related to forms and short
prose passages.
 Examples: job applications, payroll
forms, bus schedules, maps, and
drug and food labels.

©Ann Rathbun, Ph.D.

 Types of literacy
Can I search, comprehend and use information
found in these types of documents or forms???

Quantitative Literacy
 The knowledge and skills required to

perform tasks related to numbers

and numeracy.
 Examples: balancing a checkbook,

figuring out a tip, or determining

amount of interest on a loan.

©Ann Rathbun, Ph.D.

 Why Health Literacy?
 Low health literacy can have an
impact on anyone - regardless of
age, race, education or income level.
 Patients/Clients who have difficulty
understanding health information are
at a higher risk for poor health
outcomes.
- Pfzierhealthliteracy.com

©Ann Rathbun, Ph.D.

Health Outcomes

©Ann Rathbun, Ph.D.

 Individuals with low health
literacy skills are much more
likely to:
 Skip prevention services (vaccines,
mammograms, pap tests,
educational programs, etc). (Weiss,
1999)
 Therefore are “sicker” when they do
enter the healthcare system
 Have chronic conditions
 are less likely to manage them effectively
and are less knowledgeable about their
disease (HIV,
©Ann diabetes,
Rathbun, Ph.D. high blood
 Individuals with low health
literacy skills are much more
likely to:
 Engage the healthcare system
through preventable hospital visits
and admissions
 Stays are 2 days longer
 Studies have demonstrated a higher rate of

hospitalization and use of emergency

services
 This higher use is associated with higher

healthcare costs. Kirsch, Jugebut, Jenkins, &

 Some estimates have Ph.D.
©Ann Rathbun, been as high as
Kolstad. $73
1993
More on the financial impact….

 A 2-year outcome study (by The

Kaiser Foundation) found that the
use of a self-help handbook for those
with lower health literacy resulted in
a:
 12.2% reduction in primary care visits
 17.1% reduction in urgent care visits

 15.4% reduction in emergency room visits

©Ann Rathbun, Ph.D.

 Individuals with low health
literacy skills and Diabetes:

 Were less likely to have effective glycemic

control
 Were more likely to report vision problems
caused by their diabetes

Schillinger, Grumbach,
Piette, et al. 2002
©Ann Rathbun, Ph.D.
 Individuals with low health
literacy skills are much more
likely to:
 To report their health as “poor” – or
not be knowledgeable enough to give
an accurate estimate of their own
health (Kentucky)
 Report a sense of shame about their
skill level.
 As a result, they may hide reading or
vocabulary difficulties to maintain their
dignity ©Ann Rathbun, Ph.D.
 Who is at risk?

 Those who live in poverty.

 These individuals are more likely to:
 be exposed to environmental and
occupational hazards which impact health
 have limited or substandard educational,

housing, and employment opportunities

which affect health and/or
 have limited access to health promotion,

disease prevention, and curative programs

which ensure health.
©Ann Rathbun, Ph.D.
 Who is at risk?
 Those with overall poor literacy rates
 Older individuals
 Those with low levels of education
 Those who have been socialized to be
modest
 Those who have been socialized to respect
the “white coat”
 Anyone who does not “understand”
medical jargon!!!
©Ann Rathbun, Ph.D.
 Health Literacy in the US
NAAL 2003
 Majority of adults
(65%) in the US
had INTERMEDIATE
or PROFICIENT
health literacy
 36% of adults had
Basic or Below
Basic health
literacy.
NCES, 2003
©Ann Rathbun, Ph.D.
 Health Literacy in the US
NAAL 2003
 Older adults (65+)
 40% Intermediate or
Proficient
 60% Basic or Below
Basic

 Education Level
 77% of those with some
high school or less than
a high school education
had Basic or Below
Basic health literacy.
NCES, 2003
©Ann Rathbun, Ph.D.
 Health Literacy in the US
NAAL 2003
 Adults with employer based health
insurance had the HIGHEST health
literacy rates.
 Adults receiving Medicare, Medicaid
or those who had no health insurance
had lower health literacy than those
covered by “other” health insurance.

NCES, 2003
©Ann Rathbun, Ph.D.
Literacy in Kentucky
2003 NAAL

-2003 NAAL

©Ann Rathbun, Ph.D.

Literacy in Kentucky
2003 NAAL

-2003 NAAL

©Ann Rathbun, Ph.D.

 Literacy in Kentucky
2003 NAAL
 Similar to the US as a nation,
average literacy of Black Americans
was lower than the average literacy
of White Americans (in all types of
literacy)

-2003 NAAL

©Ann Rathbun, Ph.D.

Literacy in Kentucky
2003 NAAL

-2003 NAAL

©Ann Rathbun, Ph.D.

 Implications for the
Commonwealth
 If Kentuckians are less proficient in
prose and quantitative literacy this
might mean that
 We don’t read announcements, warnings, or
printed health information well.
 We may not be able to accurately order

medications, figure out how much money we

have to budget properly.

©Ann Rathbun, Ph.D.

 Implications for the
Commonwealth
 Special attention to health and
literacy of minority individuals
 Age (those over 65)
 Race (Black individuals and non-English

speakers)

©Ann Rathbun, Ph.D.

 Can we generalize for the
entire state?
 Due to the fact that there are higher levels
of unemployment in Appalachian counties
as compared to the rest of the counties in

NO
the state (U.S. Census, 2000).
Due to the fact that there are higher levels
of poverty in Appalachian counties as
compared to the rest of the counties in the
state (U.S. Census, 2000).
 Due to the fact that, in 1992, there were
lower rates of literacy in Appalachian
counties as compared to the rest of the
counties in the state (Kentucky Department of
Education, 1997). ©Ann Rathbun, Ph.D.
 Figure 19: Kentuckians Receiving Welfare by
Literacy Level

0
5 11
1
Literacy Levels

8
4 7
8

14 Q u an titative
3 16
D o cu m en t
13
P ro se
22
2 26
28
1=lowest literacy
45 level
1 40
46
5=highest literacy
level
0 10 20 30 40 50
*Percentage Receiving Welfare

Kentucky Adult Literacy Survey, 1995 *Receives one or more of AFDC, SSI, or Food Stamps

Kentucky Department for Adult

©Ann Rathbun, Ph.D.Education and Literacy, 1997
Figure 16: Kentucky Average Prose, Document, and
Quantitative Proficiencies by Poverty Status

500

400
Average Proficiencies

304 298 295

300 248 253 244

200

- 56 points - 45 points - 51 points

100

0
P ro s e Docum ent Q u a n tita tiv e
No t P o o r P o o r \ N e a r P o o r*

Kentucky Adult Literacy Survey, 1995 *As Defined by U.S. Census Bureau

©Ann Rathbun, Ph.D.

Figure 2: Average Kentucky Prose, Document,
and Quantitative Proficiency by Region
Prose
500

400

Average Proficiencies
303 294 285 282
300 264

200

100

0
Bluegrass Louisville Northern Eastern Western

Document
500

400
Average Proficiencies

299 291 283 265 281

300

200

100

0
Bluegrass Louisville Northern Eastern Western

Quantitative
500

400
Average Proficiencies

291 284 279 278

300 264

200

100

0
Bluegrass Louisville Northern Eastern Western

©Ann Rathbun, Ph.D.

Kentucky Adult Literacy Survey, 1995
What next??

©Ann Rathbun, Ph.D.

 Things you can do
 Educate yourself !!!
 Test your written materials for
readability
 Take a class on health
communication
 Find and use web resources

©Ann Rathbun, Ph.D.

GREAT Resources !!!

Most are FREE!!!

©Ann Rathbun, Ph.D.

 The NAAL 2003 Report
 http://nces.ed.gov/pubsearch/pubsinfo.as
http://nces.ed.gov/pubsearch/pubsinfo.a

F E
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©Ann Rathbun, Ph.D.
 Assessing Written Materials
 Resources $35
AMA Foundation Toolkit
Accessible online at http://www.ama-
assn.org/ama/pub/category/9913.html

NCI-The Pink Book

Making Health CDC - Simply Put
Communication Programs NCI-Clear and Simple
Work

F E F E
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©Ann Rathbun, Ph.D.
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 Beyond the Brochure
 http://www.cdc.gov/dhdsp/CDCynergy_tr

F E
RE
©Ann Rathbun, Ph.D.
 Communicating Health: Priorities
and Strategies for Progress
Action Plans To Achieve the Health
Communication
Objectives in Healthy People 2010

 http://odphp.osop
hs.dhhs.gov/proje F E
cts/HealthComm/ RE

©Ann Rathbun, Ph.D.

 Joint Commission’s report:
“What Did the Doctor Say?”
http://www.jointcommission
.org/NewsRoom/PressKits/H
ealth_Literacy/

F E
RE

©Ann Rathbun, Ph.D.

 FREE SMOG calculator
 http://www.harrymclaughlin.com/SMOG.htm

EE
FR

©Ann Rathbun, Ph.D.

 Do we have to serve the individuals
who don’t read well and,
consequently, are not the most
educated consumers?
 NO !
But it’s the RIGHT THING to do !

©Ann Rathbun, Ph.D.