You are preparing the patient for discharge.

And you are taking them through what they should do when discharged.

You think you have explained what to do in the event of a change in their health.

But you are worried because they are unable to understand exactly what they have to do with a most important medication that has serious complications if taken incorrectly.

Health literacy (HL) is the ability to obtain, process, and understand basic health information and services needed to manage one’s health and make appropriate health decisions.

Inadequate HL is where an individual has problems with basic health-related tasks such as how to manage the medication that has potentially serious complications.

As well as trouble with following prescription instructions, other examples of inadequate HL are not being able to calculate dosages, completing medical history or insurance forms, communicating with health care providers, understanding the risks and benefits of procedures, and interpreting test results such as blood glucose levels.

There are numerous skills that determine health literacy.

They are print, oral and numeracy.

Print literacy includes reading, interpreting, and understanding written information.

Oral literacy is speaking and listening effectively.

And numeracy is applying quantitative information.

Inadequate HL is most common in older adults.

In particular, they are older, male, from a minority group, low income and education and are generally sicker with poorer physical and mental health.

The mental health characteristics that are most prevalent with HL are low general literacy, poor decision-making ability, reduced cognitive functioning and a lack of social supports.

Physical health characteristics associated with HL are lack of engagement in health-promoting behaviours such as exercise, reduced physical functioning, more chronic conditions, poor self-care, increased mortality risk and poorer overall physical health.

Patients that rate their health as only fair or poor are twice as likely to have inadequate HL than those that rate their health as good or excellent.

Inadequate HL more strongly predicts a patient’s health status than age, income, education or race.

It also impacts upon patient satisfaction with providers, services, and overall care.

As well as compliance with following preventive measures and services and health care utilization.

Patients with HL have fewer cancer screenings and flu vaccination and higher emergency service services due to the lack of compliance with health prevention advice.

Making sound health care decisions are important for optimizing health outcomes, continued independence, quality of life and successful aging.

Patients with poorer health or more disabilities wrestle daily with self-care and managing complex conditions.

Older adults with HL and asthma and/or coronary heart failure have worse outcomes than those with adequate HL.

So if the patient you are about to discharge is older, male, less educated and in poorer health with more chronic conditions than normal, you may want to spend some extra time going through what should happen upon discharge.

You may need to call a significant other to help the patient with the steps that are required upon discharge.

As well as arranging for a medical review a week after discharge.

A nation wide campaign to improve health literacy would result in increased patient satisfaction, better compliance with preventive services and reduced healthcare spending.

But that is a topic for another time.

To learn more about health literacy,

MacLeod, Stephanie, et al. “The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults.” Geriatric Nursing (2017).