Health literacy is a constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment.1 Patients with poor health literacy levels have difficulties that range from reading labels on a pill bottle and interpreting blood sugar values or dosing schedules to comprehending appointment slips, educational brochures, or informed-consent documents. Patients with poor health literacy not only have limitations in reading but also may have difficulties processing oral communication and conceptualizing risk.2,3 In the context of a health care system in which scientific advances and market forces place greater technical and self-management demands on patients, poor health literacy may be a particularly important barrier to chronic-disease care.
Poor health literacy is more common among patients who have low educational attainment and among immigrants, older patients, and racial and ethnic minorities.1 Research has shown that poor health literacy is most prevalent in public hospitals but is also common among the elderly in private-sector settings. A recent study of Medicare managed care enrollees demonstrated that more than one third had poor health literacy.4 Poor health literacy is common among patients with chronic medical conditions, such as type 2 diabetes, asthma, AIDS (acquired immunodeficiency syndrome), and hypertension.5- 9