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Cultural Competence in Health Care

What is Health Literacy?

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions.

Low health literacy is more prevalent among:

  • older adults
  • minority populations
  • those of low socioeconomic status
  • medically underserved people.

Why is Health Literacy Important?

People with low health literacy may have difficulty:

  • locating providers and services
  • filling out complex health forms
  • sharing their medical history with providers
  • seeking preventative health care, knowing the connection between risky behaviors and health
  • managing chronic health conditions
  • understanding directions on medicine.

Patients' health literacy may be affected if they have:

  • health care providers who use words that patients don't understand
  • low educational skills
  • cultural barriers to health care
  • Limited English Proficiency (LEP).

Assessing Health Literacy

There are different tools that can be used to assess health literacy for research and patient care purposes. Each tool measures an aspect of health literacy such as the ability to read, recognize medical terms, or perform calculations. Patients may demonstrate adequate health literacy with one assessment tool but score below adequate health literacy on another. Highly educated patients may not know how to make an appointment at the clinic while an uneducated patient may be extremely competent with taking their medications as prescribed. It is important not to judge a patient’s health literacy based on perceived capabilities. Clinicians may not be aware of what a person does or does not know; therefore, it is recommended that universal precautions are used with all patients.

Universal precautions refer to taking specific actions that minimize risk for everyone when it is unclear which patients may be affected. For example, health care staff take universal precautions when they minimize the risk of spreading blood-borne disease by using gloves and proper disposal techniques.

Experts recommend assuming that everyone may have difficulty understanding health information. All healthcare settings should ensure that universal precautions for health literacy are in place to promote better understanding for all patients - not just those you think need extra assistance. Research suggests that clear communication practices and removing literacy-related barriers will improve care for all patients regardless of their level of health literacy.

If health literacy assessments are administered, this information can be documented in the patient’s medical record. For users of the Resource and Patent Management System (RPMS), low health literacy scores can be documented under the barriers to learning health factors: choose the “low health literacy” health factor and enter the test and score in the comments field. This can inform other users of specific aspects of health literacy that should be considered when creating the treatment plan with the patient.

Taken from the Indian Health Service (IHS) website: