Improving Health Literacy and Confidence With the Healthcare System

For one out of every three U.S. adults, the symptoms that bring them to their healthcare provider aren’t their only health challenge: About 77 million Americans have low health literacy, meaning they struggle with regular activities such as interpreting basic health information, following medication directions, and adhering to a physician’s instructions.

Patients with low health literacy experience worse health outcomes, too (PDF, 467 KB). They’re more likely to smoke, skip preventive measures, and enter the healthcare system later in their sickness. Improving patients’ health literacy often falls to providers, who are trained to screen for low literacy and use their expertise to answer questions.

But sometimes, asking questions can be hard when patients don’t know what they don’t know. Patients can use the same tests providers use to measure health literacy and figure out where they have gaps in understanding.

Continue reading to learn more about how to measure health literacy and for guided instruction on improving your own health knowledge.

What Is Health Literacy and Why Is It Important?

According to the CDC, health literacy is “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.”

“Capacity” is the operative term—people who are health literate don’t need to know everything a health expert knows. Instead, much like reading literacy, they should have the ability to engage in the process.

What are health literacy skills? Individuals with a functioning level of health literacy are able to:

  • Complete medical forms accurately.
  • Find a provider and make an appointment.
  • Share their health history.
  • Follow instructions to manage chronic conditions.
  • Understand directions on a prescription label.
  • Grasp basic mathematical concepts.
  • Exhibit and expand their basic health knowledge.

There are disparities among the population when it comes to who is most likely to have low health literacy. Adults below the poverty level and uninsured or publicly insured individuals tend to be less health literate, according to a report from the U.S. Department of Education on the health literacy of adults (PDF, 1.2 MB). Additionally, members of racial and ethnic minorities and individuals who did not graduate high school also have lower health literacy levels.

Baylor University Robbins College of Health and Human Sciences Associate Professor Beth Lanning, PhD, MCHES, said that health literacy is part of the foundation of a successful health interaction.

“If [patients] don’t understand the information they’re being given, they’re not going to use that information,” she said.

Research shows that a shaky foundation creates poor health outcomes throughout life. Individuals with low health literacy are more likely to engage in high-risk health behaviors like smoking.A parent’s literacy level can affect their child’s health, too—children with asthma experience worse care measures when their parents have low literacy.Often, people who have more health problems compound those issues with difficulty understanding health information, and they are more likely to have difficulty managing chronic conditions if they have low health literacy.

How Do We Measure and Improve Health Literacy?

Professor Lanning was a member of a team of Baylor faculty who researched the effectiveness of several health literacy measurement tools. The study, led by fellow Baylor professor Kelly Ylitalo, PHD, outlines two tests: the Newest Vital Sign (NVS) nutrition label test (PDF, 1.5 MB) and a single-item confidence questionnaire.

The NVS requires patients to answer six questions regarding an ice cream label about serving size, percentages, and allergies in order to test literacy. The item on the questionnaire asks “How confident are you filling out medical forms by yourself?”

Baylor researchers found that 14 percent of patients exhibited adequate health literacy levels. The confidence question was also an accurate indicator of a patient’s performance on the NVS test.

Below are two resources for adults, educators, and new patients to practice their health literacy skills using the tests described above.

Understanding a Nutrition Label

The NVS measures numeric and health literacy and tests a patient’s math and reading skills with six questions about a sample ice cream nutrition label. Lanning said this test is less about someone’s ability to describe the purpose of calories or the nutritional value of fiber and instead focuses on comprehension skills. Some examples of questions on the NVS are:

  • If you eat the entire pint of ice cream, how many calories will you consume?
  • If you are allergic to peanuts, is it safe for you to eat this ice cream?
  • If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream could you have?

“Not only is it being able to read and know what to look for, but you also have to do some calculations,” said Lanning. “You’re asking [patients], ‘How many calories would you eat if you had the whole container?’ It’s understanding serving levels within that container and multiplying that.”

Serving size

The nutritional information listed applies to what amount of food? All the information on a nutritional label is for 1 serving.

Servings per container tells you how many servings are in the entire package. In this example, a serving is 3 cookies, and there are 6 servings (or 18 cookies) total.

Ingredients

What is in this product? Ingredients are listed from the greatest to least amount. Here, sugar is the most used ingredient. Read the ingredients list if allergens are a concern.

Calories

How many calories are in one serving? In this example, 3 cookies are 150 calories. You can find out how many of those calories come from fat by referring to the food label section, “Calories from fat.”

Raw Amount

How much of each nutrient is in 1 serving? This is shown in grams (g) or milligrams (mg). In this example, there are 100 mg of sodium in 1 serving.

Percent Daily Value

What portion of the daily recommended nutrients are in 1 serving? Values are based on a 2,000-calorie diet. In this example, 1 serving has 7 grams of fat, which is 11 percent of a person’s daily recommended fat intake.

Want to quiz yourself on these skills?

Use MPH@Baylor’s practice labels and determine if you can pass levels 1, 2, and 3.

Click here to download the Practice Reading a Nutritional Label exercise (PDF, 366 KB).

Five Things to Know When Filling Out Medical Forms

The second test is a simple question with answers that can indicate a wide set of skills: Are you confident filling out medical forms and describing your health? Answers can include responses such as “extremely confident,” “somewhat confident,” and “not at all confident.”

Patients that claim to be “confident” filling out medical forms are identified as having little difficulty understanding medical information. But not everyone feels that secure when they walk into the doctor’s office.

Lanning said that the amount and complexity of paperwork can seem daunting. She remembered how, after a series of medical visits, her own mother didn’t want to fill out forms anymore.

“Age and health really affect your ability to comprehend … and it just becomes overwhelming,” Lanning said. “I think we find that a lot of our patients, young and old, depending on their literacy and education level, feel exactly that way—probably overwhelmed by the amount of paperwork and what to fill out.”

Understanding your physical and psychological condition is a key starting point to creating sustainable outcomes and a positive relationship with healthcare providers. For young adults entering appointments on their own for the first time, individuals who have a lot of questions, and caregivers helping others navigate the health system, it can be difficult to know where to begin.

Below are five things that everyone should know about their own health to have confident interactions with healthcare providers. Included are common questions and tips for how to improve health literacy in these areas.

1. Personal Information

Personal information is the most basic knowledge needed to accurately complete medical forms. These identifiers answer questions such as “Who are you and how can we contact you?” Establishing a robust personal profile with a provider ensures you can always be reached and your preferences are respected and followed.

Things to Know:

  • Full and legal name
  • Home address
  • Date of birth
  • Emergency contact information
  • Phone number and email address
  • Preferred method of contact
  • Changes in marital or job status

Remember:

  • Arrive 15-30 minutes early to give yourself time to fill out forms.
  • Bring a personal identification card so you have an easy reference point.
  • Use a piece of paper to cover the page and reveal questions one at a time, making it easier to read and less overwhelming.

2. Health Insurance

Health insurance is payment coverage for medical, dental, behavioral, and prescription services through a private company or the government, like Medicare or Medicaid. Households can usually acquire coverage through an individual’s job or insurance plan. Each policyholder should have their own insurance card with a personal ID number.

Things to Know:

  • The information presented on your insurance card
  • If you’ve met your deductible for the year
  • What the copay will be
  • If a provider is in or out-of-network

Common questions:

What is a sliding scale? A sliding scale is a method of charging patients without insurance coverage a reduced rate for their services. The amount charged is based on a variable, usually income.

Do I have to pay at the time of the appointment? That depends on the office and provider. Ask when you make your initial appointment and see what options they have for deferring payment or paying in installments, if necessary.

Remember:

  • Bring your insurance card to every appointment. If you have questions, the office staff can call your insurer to resolve any issues.
  • Select your provider with the insurance company before your appointment, if required. They may need to send you a new insurance card.
  • Check coverage levels and network status in advance either by calling the insurance company or logging on to their website.

3. Reason for the Appointment

Your symptoms answer what could likely be the first question your healthcare provider asks you: What brings you here today?

Things to Know:

  • When you made the appointment
  • What kind of discomfort you’re experiencing and where
  • How long you’ve been experiencing symptoms
  • How often you experience the symptoms
  • Changes in patterns, like rapid weight gain or loss of sleep
  • Objectives for the appointment

Commom Questions:

I made the appointment because I need a physical—there’s nothing wrong with me. What do I say? Physicals are annual checkups usually covered entirely by insurance, for preventive care. If that’s the reason for your appointment, it’s perfectly fine to say you are experiencing no symptoms.

I don’t know how to word what I’m feeling. Share that with the provider. They can offer visual tools to help you express your concerns or discomfort.

Remember:

  • Use travel time to think about your goals for this trip.
  • Record how you’re feeling at the time of making the appointment. What prompted you to make the call? Continue to write down the frequency or intensity of symptoms leading up to the appointment and bring the document with you.
  • Ask open-ended questions if you’re helping someone else through the appointment. Instead of “Your stomach hurts, right?” try “How do you feel after you eat?”

4. Medical History

Your medical history describes your past interactions with the healthcare system and your outcomes. Most of it should exist in your patient documents, which many providers will ask that you share when you enter their practice. If you’re transferring offices or switching providers, contact your former medical office and sign a release form that will allow them to forward your past medical history to your new provider.

Things to Know:

  • Allergies
  • Vaccination history
  • Medication and prescriptions used
  • Past surgeries and hospitalizations
  • Drug and alcohol use and frequency
  • Sexual history
  • Last fall and frequency of falls

Common questions:

What if I can’t remember everything? You don’t have to remember everything. Most of these questions can be answered using patient documents collected throughout your interactions with providers. Focus on remembering the most recent instances that aren’t captured there.

What if I get something wrong? Your provider will not base a new treatment or medication recommendation based solely on your memory alone. Share what you can to provide helpful context, but don’t feel like it’s your responsibility to keep track of everything.

Remember:

  • If you’re switching providers, call in advance of your new appointment and have them request your medical records. Contact the old provider, too, and sign a release form granting them permission to fulfill the request.
  • Work through your own medical history using categories that make sense to you. Do you need to recall what procedures you’ve had? Think chronologically, recount medical treatments from head to toe, or reflect on the different categories of operations to organize your thoughts.

5. Family History

Family medical history is higher level and focuses on answering the question “How could your family’s health be affecting your experiences?”

Things to Know:

  • Family members’ chronic conditions or diseases like:
    • High cholesterol
    • High blood pressure
    • Cancer
    • Heart disease
    • Diabetes
    • Dementia
  • When were they diagnosed?
  • Are they medicated for it?
  • Mental health conditions like alcoholism or depression
  • Pregnancy complications

Common questions:

How far into my family history do I need to go? You don’t need a full family tree, but start with your biological parents and whatever information you can gather from them. After that, move on to their biological parents.

What if I can’t find the answer? If you don’t have access to information for your biological parents, don’t guess at what it could be. Share that you can’t provide those answers and let your provider guide you to next steps. Some providers will refer you to a genetic counselor who can test what hereditary conditions run in your family.

Remember:

  • Document what you find by jotting down notes and bringing them to the appointment.
  • Ask family members about their medical conditions. If they can’t remember, ask them to contact their own provider to look them up.
  • When it comes to hereditary conditions, your family’s health directly affects your own. Even if it feels uncomfortable, it’s worth starting a conversation.

Citation for this content: The MPH online program from Baylor University's Robbins College of Health and Human Sciences.