Low health literacy linked to poorer outcomes, use of health services

Patients with low health literacy are less likely to use health services and more likely to have poor health outcomes, according to a new study.

Researchers performed a systematic review to determine whether low health literacy affects health outcomes, costs and disparities. Ninety-six studies of good or fair quality in 111 articles were examined, 98 dealing with health literacy, 22 dealing with numeracy (defined as the ability to use quantitative information for such tasks as interpreting food labels, measuring blood glucose levels and adhering to medication levels), and 9 dealing with both. The study, which was funded by the Agency for Healthcare Research and Quality, appears in the July 19 Annals of Internal Medicine.

The authors found a consistent association between low health literacy and increased hospitalization, more use of emergency care, and less screening mammography and influenza vaccination. Low health literacy was also associated with reduced ability to take medications appropriately and to interpret labels and health messages correctly. Elderly patients with low health literacy were in worse overall health and had higher mortality rates. Racial disparities for some outcomes were linked to low health literacy, although the authors rated the available evidence as low. In addition, no firm conclusions could be drawn about the relationship between health outcomes and numeracy alone because of inadequate data.

The authors noted that they included only English-language studies and that they were unable to use Medical Subject Heading terms in their literature search. However, they concluded that low health literacy is associated with worse health outcomes and poorer use of health care services, and called on policymakers, clinicians and other stakeholders to find effective ways of addressing the problem.

The July/August issue of ACP Internist offers advice on communicating with patients who may have low health literacy.

Many related resources, including HEALTH TiPS for patients, are available online from ACP Foundation.