© 2007 Aetna Inc. Aetna 2007 © Aetna 2008 African American History Calendar Health Marginal Literacy, A Growing Issue in Health Care Literacy By Janet Ohene-Frempong, M.S. Patients are often confused. Health care But there’s also good news: Reading scores for blacks and concepts. They may be unclear about what to do and providers often don’t know it. have gone up in the 10 years since the last national why to do it. They read well. But, they are just not familiar Many people are not aware of the problem of marginal survey was conducted. So the gap is closing. with complex health care issues and systems. They have literacy, which means being able to read, but not with low health literacy. real skill. Individuals fall into poor health for many reasons. Shame can get in the way of good There also are many reasons why people fail to follow health care. Steps can be taken to address the issue. through on what their health care providers ask them to People go out of their way to hide from their doctors that they Marginal health literacy is a serious problem. Steps can do. One main reason for both of these issues can be linked can’t read well. This is true no matter what a person’s age or be taken to correct it: to reading skills. More people than we think do not read race. Researchers have shown that “because of the shame that Expand awareness across the nation about this issue. they hold, some patients may be intimidated and less likely to well. In recent years, researchers have shown that reading Create policies to provide health care information ask questions or admit they do not understand.” skills make a difference when it comes to staying healthy. that is easy to read, follow, understand and relate to. This has been proven in a number of health conditions. Support health care providers in communicating Diabetes is one. Asthma is another. Confusion and shame should not be mistaken for lack of interest. more clearly. The issue affects Americans of all races. Sometimes patients don’t do what they agree to do. And Support efforts to improve the literacy skills of both In 2003, the U.S. Department of Education released the some health care providers assume this is because patients children and adults. results of its National Assessment of Adult Literacy (NAAL). don’t care. But, many such people do care. They simply Push for more research and funding to find and The NAAL measured reading and math skills of thousands struggle in silence. So, casting blame is not helpful. Providers apply more solutions. of adults in the U.S. The results showed that 43 percent of can begin to look more closely for signs of confusion. The more we do together to address this issue, the adults in the U.S. are performing at the two lowest levels healthier a society we will become. It just takes a little of literacy. This figure includes people of all races and ages, Staying healthy can be hard. It often calls dose of understanding. white and black, young and old. Many adults in the U.S. for strong reading skills. are not at ease dealing with words and numbers in print. People have to do many things to manage their health. Janet Ohene-Frempong, president of J O Frempong & They need to fill out forms to get care. They need to read Associates, is a plain language and cross-cultural complex instructions before tests can be done. They need to communications consultant with over 25 years of experience But this is a special issue for in patient/provider communications. African Americans. take the correct amount of medication at the correct time. The NAAL also looked at reading skills by race and Yet, many instructions and forms are written for very strong References McCall, C. (1989). A Historical Quest for Literacy. Interracial Books ethnic group. It showed that an even greater percentage readers. This makes it hard for the thousands of people who for Children, 19 (3-4): 3-6. of African Americans — 67 percent — were performing are not strong readers to manage their health care. at the two lowest levels of literacy. Now, this is not Baker, D. W.; Parker, R. M.; William, M. V.; Pitkin, K.; Parikh, N. S.; Coates, W.; and Imaru, M. (1996). The Health Care Experience of Patients with “I had some papers, something that African Americans want to hear. Who When people don’t read with ease, Low Literacy. Archives of Family Medicine, 5: 329-334. wants to be labeled as not being able to do well in skills the health results can be serious. but I didn’t know they such as reading or math? To understand this, we need to People who do not have strong reading skills are more Doak, C. C.; Doak, L. G.; and Root, J. H. (1996) Teaching Patients with Low Literacy Skills. Second Edition. Philadelphia, PA: JB Lippincott Company. take a look back in time. likely to end up in the hospital. They are more likely to need treatment for illnesses that could have been Williams, M. V.; Baker, D. W.; Parker, R. M.; and Nurss, J. R. (1998). were prescriptions, For African Americans, prevented. They also are more likely to die sooner Relationship of functional health literacy to patients’ knowledge of their and I walked around history may tell us why. because of their health problems. chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine, 158 (2): 166-72. If reading skills have been a concern, this should come as for a week without no surprise. According to Cecelia McCall, a noted professor Even people with strong reading skills Web references A First Look at the Literacy of America’s Adults in the 21st Century, of English, African Americans are “the only Americans who often need special attention. NCES Number: 2006470 Release Date: December 15, 2005. my medications.” were deliberately, legally and systematically prevented from A person can have strong general literacy skills and still having access to the book.” They are “the only Americans have low health literacy skills. Why? Because even people The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy, NCES Number: 2006483 From an article titled “The Health Care Experience who had to litigate for what other Americans took for with strong literacy skills can find health information Release Date: September 6, 2006. of Patients With Low Literacy” granted — decent schools.” In fact, she reminds us that confusing. Providers should not assume that people who By David Baker, Ruth Parker, Mark Williams during slavery, many African Americans risked punishment are good readers also are clear about how to manage their and others Published in the Archives of Family Medicine, 1996 and even death by learning to read. health care. People often are confused by medical words Health information that is hard to This is why health literacy advocates across the country Educators such as Kari Trotter Wall, Pharm.D.; and understand is everywhere. It touches are trying to make easy-to-understand information Sharon L. Youmans, Pharm.D., M.P.H.; are making a us at pharmacies, in doctors’ and dentists’ available to everyone. At Aetna, we believe that people difference. These leaders teach hundreds of pharmacists offi ces, and at health centers and hospitals. of all literacy levels can take control of their health when each year how to be more sensitive to cultural differences. It even affects us in the home. communications are clear and simple. Nathan Fletcher and Alison Riddle-Fletcher, a husband-wife More than 90 million Americans are known to be dealing team of dentists, have come up with unique ways to raise It takes more than patience, persistence and with low health literacy. Many more are unknown. Like their patients’ dental IQs. They give their patients photos common sense to break down this information. obesity, it impacts people of all racial and ethnic back- of an egg timer set to the right brushing time. It takes the guidance and support of health grounds. However, low health literacy is more prevalent Health literacy now is being addressed in unique settings care professionals devoted not only to among elderly African Americans and Latinos. such as churches, libraries and even barbershops. People providing health care, but also to making This year, Aetna focuses its 27th African American History gather in these places to share information. Together, people understand their health. Calendar on health literacy. Low health literacy is a growing they become smarter health consumers. barrier to good health care. To do its part, Aetna is committed Raising health literacy does require a village. The more we to making consumer information easier to understand. know about it, the more we can do. The more we do, The problem of health literacy is becoming more well the more healthful the results. known. African American communities across America are focusing on it in many ways. There is more health education in communities, and health leaders are rethinking the words they say and write. African American History Calendar January 2008 www.aetnaafricanamericancalendar.com In the Home Knowledge is power. … I didn’t know I was sick, Derek E. Faison Jo Ann Pegues “ Former President and CEO Project Manager but I do now; and I’m a man on a mission. Faison Office Products Company Focus on Diabetes Program ” — Derek E. Faison Denver, Colorado The Center for African American Health Denver, Colorado When Derek Faison learned he had diabetes, he had diabetes.