Do our patients understand?

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Ashley Moore, RN, MSN, ANP-BC

Nurses serve as patient educators across the healthcare spectrum. We strive to provide the knowledge needed to promote health and improve outcomes and quality of life. Although we may assume that our patients comprehend the information being provided, as many as 90 million Americans, or half of our adult population, have difficulty understanding health information.1 These patients are unable to grasp simple health instructions that affect their ability to actively participate in their own care. Healthy People 2010 defined health literacy 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.”2

As the responsibility of self-care demands increase, it behooves us to understand the nature and implications of low health literacy. Identifying at-risk individuals can be challenging and should not be assumed according to subjective impressions such as educational level or socioeconomic status.3 Populations that are more vulnerable include the elderly (age 65+ years), minority and immigrant populations, and those with chronic mental or physical health conditions.4

Patients with low health literacy report poorer health status and are less likely to comply with treatment recommendations and self-care regimens. Low health literacy is associated with an increased use of emergency services, poorer control of chronic illness, and more than double the risk for hospitalization.3 According to the Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy, “Groups with the highest prevalence of chronic disease and the greatest need for health care have the least ability to read and comprehend information needed to function as patients.”1 The economic consequences of this problem is staggering, costing as much as $58 billion annually.3

Despite advances in drug and device therapies, heart failure remains the single most frequent cause of hospitalization in those aged more than 65 years and accounts for more than one million hospital discharges annually.5 Given this information, the connection between heart failure and health literacy is undeniable. To take this logic a step further, the contribution of low health literacy to hospital readmission should be objectively assessed and effectively addressed.

As nurses, we are uniquely positioned to assist this vulnerable population. The American Association of Heart Failure Nurses is poised to launch a comprehensive initiative addressing the educational needs of our patients, incorporating printed materials, web-based resources, and the use of cell phone audio information. This will offer an additional tool to improve the health literacy and outcomes of patients with heart failure.