NEWS

By DAVID WILLIAMSON
UNC News Services

CHAPEL HILL -- Almost half of American adults -- some 90 million U.S. residents -- lack sufficient literacy skills, including reading ability, to take full advantage of the most useful medical technologies such as Pap smears and mammograms.

Most of those adults also are less likely than others to get flu and pneumonia vaccines or receive other kinds of routine or specialized health care.

Those are among the chief findings from a report of a new national study conducted by researchers at the University of North Carolina at Chapel Hill and RTI International and released today (April 8).

People with low health-literacy skills are more prone than others to seek emergency department treatment inappropriately and be admitted to a hospital, the researchers say.

The Agency for Healthcare Research and Quality commissioned the study at the request of the American Medical Association and presented it at a news conference in Washington, D.C. UNC School of Medicine faculty members and RTI International staff reviewed and synthesized the massive body of previous research on health and literacy in the United States. The Institute of Medicine of the National Academies issued a closely related report simultaneously.

Dr. Michael Pignone, assistant professor of medicine and associate chief of general internal medicine at UNC, led the RTI-UNC team.

He and colleagues searched numerous databases such as MEDLINE to identify and review more than 3,000 scientific articles about the relationship between literacy and patients’ health. They also examined all published strategies they could locate that were designed to improve health among people with low literacy skills.

"We found that low literacy among millions of U.S. residents has an enormous negative effect on the nation’s health," Pignone said. "While several interventions offer promise for addressing literacy-related barriers, limitations in study design make drawing conclusions about the effectiveness of the most promising activities difficult. Further research is needed to understand better the types of interventions that are most effective."

"Health literacy is the currency of success for everything that we do in primary and preventive medicine," said Surgeon Gen. Richard H. Carmona. "Health literacy can save lives, save money and improve the health and well-being of millions of Americans."

People with a low level of literacy have difficulty reading simple information such as directions for taking medications or hospital discharge instructions, said Dr. Carolyn M. Clancy, director of the AHRQ. They are also more likely to be hospitalized, which may be because physicians are concerned about patients’ abilities to follow basic instructions and care for themselves at home when they are sick. Low literacy plays an important role too in health disparities and may contribute to lower quality care and even medical errors.

"For the 90 million Americans with limited literacy skills, it’s tough to read the front page of a newspaper or a bus schedule, much less the complicated documents that go along with being a patient in our country today," said Dr. John C. Nelson, AMA president-elect. "Since 1998, the AMA has been tackling the problem of health literacy because we believe that quality health care depends on patients who are active participants in their own care, and low health literacy robs them of that opportunity."

Pignone said the RTI-UNC team’s review found that people with low literacy were more likely to have difficulty understanding informed consent forms and their children’s diagnoses and medication instructions. They were also less likely to know about the health effects of smoking, diabetes, asthma, AIDS and post-operative care.

He and his colleagues, Drs. Darren DeWalt and Stacey Sheridan from UNC and Nancy Berkman and Kathleen Lohr from RTI International, also found evidence that well-conceived interventions such as easy-to-read guides and other comprehension aids can at least improve the outcome of knowledge for both lower- and higher-literacy patients.

At UNC, DeWalt is a fellow in the Robert Wood Johnson Clinical Scholars Program, and Sheridan is assistant professor of medicine. Berkman led the RTI staff’s work on the study, and Lohr co-directs the RTI-UNC Evidence-based Practice Center. Papers based on the research are being reviewed and will be published later.

An AMA health literacy kit for physicians and other health professionals is available on line at http://www.amafoundation.org. The report is available at http://www.ahrq.gov/clinic/evrptfiles.htm#literacy or by calling (800) 358-9295.

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Note: Pignone can be reached Thursday, April 8, at (919) 616-0449 and at 966-2276, 966-1369 or pignone@email.unc.edu thereafter.

UNC Contact: David Williamson, (919) 962-8596

RTI Contact: Reid Maness, (919) 541-7044