Reducing the Cost of Healthcare…By Teaching Reading

The other day I stumbled across an article that had something interesting in it. Apparently, there was a Johns Hopkins study of two groups of cancer patients. One group was literate. The other group was not functionally literate. Over the length of the study the literate group had half the morbidity and mortality of the illiterate one. People who can be proactive in their own treatment, read the labels on medicine bottles, follow written instructions stay healthier, are more likely to seek help (less shame) and, consequently, cost less.

I can’t put my hands on either the article nor the study. If anyone out there can point me in the right direction, I’d appreciate it.

This article on “health literacy” covers much the same territory:

Patients who understand and can apply written or verbal information and instructions have better outcomes. The American Hospital Association estimates that between 55% and 75% of all hospital admissions are surgically related, and studies have shown that patient education contributes to a positive postoperative recovery. It follows, therefore, that patient education in the perioperative setting is particularly important. (15)

and

Consequences of unrecognized illiteracy and language barriers. “Patients and their families are dying for information, sometimes quite literally.” (27) Although specific data regarding the effect of low literacy on clinical outcomes is lacking, it is a logical assumption that poor outcomes as a result of patients misunderstanding their instructions wastes health care dollars. A task force of the American Medical Association reviewed and analyzed research and literature regarding health literacy, concluding that “the consequences of poor health literacy are probably far more serious than shown by research data.

and

Medication errors and adverse medication reactions can result from patients’ inability to follow written, or even verbal, instructions. Noncompliance, a term used frequently to describe patient behaviors that deviate from the practitioner’s plan, often is attributed to a willful disobedience on the part of the patient; however, it may represent a lack of understanding of instructions. “Noncompliance often is a matter of perceptual mismatch–patients think they are expected to do one thing, and the physician expects another.” (31) This fact is best illustrated by one study in which 11.8% of 500 prescriptions were misinterpreted. (32)

Patients who have trouble reading usually also have trouble analyzing information. This impairs their ability to ask questions, thus perpetuating the problem. To avoid appearing ignorant, many patients never ask questions. (33) One author reported a situation in which a patient would not take his medication, skipped appointments with his therapist, and refused to participate in group therapy. It eventually was discovered that the patient could not read. His lack of literacy skills was seriously jeopardizing his health. (34)

It’s probably going to be more cost effective to teach people to read than it will to spend the time with the illiterate necessary to ensure that they’re able to follow a course of treatment. Lack of English aggravates the problem and it would probably be pretty rough to teach the reading of English to people who aren’t literate in their native languages and have limited English.

1 comment… add one
  • Nadine A. Bendycki Link

    I have not located the specific article you mentioned in your 12/4/07 posting, but did find a similar one which came to similar conclusions about literacy and mortality. Check out http://caonline.amcancersoc.org/cgi/content/full/52/3/134

    In the meantime, I will continue to try and locate the article. I am an independent consultant who is very interested in health care literacy.

    nab

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