A new study from Northwestern University's Feinberg School of Medicine shows that a low literacy rate can impair patients' ability to acquire vital health information and can significantly shorten their lives. The study defines "inadequate or low health literacy" as the inability to read and comprehend basic health-related materials, such as prescription bottles, doctor appointment slips and hospital forms.
The findings show that people with low health literacy have a 50 percent higher mortality rate over five years than people with adequate reading skills.
"It's a matter of life or death," said Dr. David Baker, lead author of the study and chief of general internal medicine at Feinberg. "The excess number of deaths among people with low literacy was huge. The magnitude of this shocked us."
More than 75 million adults in the United States have only basic or below basic health literacy, according to the 2003 National Assessment of Adult Literacy.
"When patients can't read, they are not able to do the things necessary to stay healthy," Baker said. "They don't know how to take their medications correctly, they don't understand when to seek medical care, and they don't know how to care for their diseases."
The study showed that low health literacy was second only to smoking as the top predictor of mortality, surpassing income and years of education.
People with inadequate literacy also have a higher rate of mortality from cardiovascular disease.
The NU study began in 1997 when research assistants interviewed 3,260 Medicare patients aged 65 and older in Cleveland, Tampa, Miami and San Antonio.
Researchers asked about participants' race and ethnicity, education, income, health behaviors and chronic medical conditions. Participants completed a test of health literacy that included reading passages and health-related materials, such as pill bottles, that required understanding numbers.
In 2003, researchers matched names in the National Death Index to determine which participants had died during in the six years since being interviewed. The results show a need for health care providers to find other means of educating their low-literacy patients about their health, Baker said.
"We need to use plain language," Baker said. "We're not talking about dumbing down material. We're talking about using simple language the average person would understand."
Baker also mentioned the importance of visual images to supplement health care information.
"If one picture is worth a thousand words, maybe one movie is worth 10 pictures," Baker said. "So, if you're going to explain to somebody with a condition called heart failure that their heart is not pumping hard enough, a moving image may show this much more clearly than words or a still image."
Baker and his colleagues are currently designing simpler health education materials by working directly with patients.
They are working to find the best words and methods to explain health information about conditions such as colorectal cancer, asthma and diabetes.
The study was published in Archives of Internal Medicine July 23.
Reach Whitney Siehl at w-siehl@northwestern.edu.
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