Health literacy - Report of the Council on Scientific Affairs

Context Patients with the greatest health care needs may have the least abi lity to read and comprehend information needed to function successfully as patients. Objective To examine the scope and consequences of poor hearth literacy in the United States, characterize its implications for patients and physician s, and identify policy and research issues. Participants The 12 members of the Ad Hoc Committee on Health Literacy, Ame rican Medical Association Council on Scientific Affairs, were selected by a key informant process as experts in the field of health literacy from a va riety of backgrounds in clinical medicine, medical and health services rese arch, medical education, psychology, adult literacy, nursing, and health ed ucation. Evidence Literature review using the MEDLINE database for January 1966 thro ugh October 1, 1996, searching Medical Subject Heading (MeSH) reading combi ned with text words health or literacy in the title, abstract, or MeSH. A s ubsequent search using reading as a search term identified articles publish ed between 1993 and August 1998. Authors of relevant published abstracts we re asked to provide manuscripts. Experts in health services research, healt h education, and medical law identified proprietary and other unpublished r eferences. Consensus Process Consensus among committee members was reached through rev iew of 216 published articles and additional unpublished manuscripts and te lephone and Internet conferencing. All committee members approved the final report. Conclusions Patients with inadequate health literacy have a complex array o f communications difficulties, which may interact to influence health outco me. These patients report worse health status and have less understanding a bout their medical conditions and treatment. Preliminary studies indicate i nadequate health literacy may increase the risk of hospitalization. Profess ional and public awareness of the health literacy issue must be increased, beginning with education of medical students and physicians and improved pa tient-physician communication skills. Future research should focus on optim al methods of screening patients to identify those with poor health literac y, effective health education techniques, outcomes and costs associated wit h poor health literacy, and the causal pathway of how poor health literacy influences health.