|ORIGINAL RESEARCH PAPER
|Year : 2013 | Volume
| Issue : 2 | Page : 85-88
A need for health literacy curriculum: Knowledge of health literacy among us audiologists and speech-language pathologists in Arkansas
Samuel R Atcherson1, Richard I Zraick1, Kristie Hadden2
1 Department of Audiology and Speech Pathology, University of Arkansas at Little Rock, University of Arkansas for Medical Sciences, Arkansas, USA
2 Center for Rural Health, University of Arkansas for Medical Sciences, USA
|Date of Web Publication||29-Oct-2013|
Samuel R Atcherson
Department of Audiology and Speech Pathology, University of Arkansas at Little Rock, 2801 S. University, Little Rock, Arkansas 72204
Source of Support: None, Conflict of Interest: None
Context: We assessed the general knowledge of health literacy and the impact of limited health literacy on patients and to society in United States (US) audiologists and speech-language pathologists in Arkansas. Methods: A 10-item survey was completed by 198 professionals and students in communication sciences and disorders in Arkansas. The 10-items were divided into one demographic question, six patient-related health literacy questions, and three systems-related health literacy questions. Results: Most professionals and students were aware that limited health literacy can be an obstacle for patients, but they were only somewhat or not aware of existing data on the average US adult reading grade level, the readability of clinic forms, or the estimated economic healthcare cost as a result of low health literacy. Discussion: Increasing the awareness of health literacy and the impact of limited health literacy among all healthcare providers would be a worthwhile endeavor. More work is needed to study health literacy in various patient populations and to develop effective approaches to combat low health literacy in the field of communication sciences and disorders, as well as other healthcare disciplines, across the globe. This study suggests that health literacy awareness training may be needed, not only in Arkansas, but also throughout the US and other countries. The outcome should bridge the health literacy and communication gap between providers and their patients.
Keywords: Audiologists, communication, health literacy, knowledge, provider, speech pathologists
|How to cite this article:|
Atcherson SR, Zraick RI, Hadden K. A need for health literacy curriculum: Knowledge of health literacy among us audiologists and speech-language pathologists in Arkansas. Educ Health 2013;26:85-8
|How to cite this URL:|
Atcherson SR, Zraick RI, Hadden K. A need for health literacy curriculum: Knowledge of health literacy among us audiologists and speech-language pathologists in Arkansas. Educ Health [serial online] 2013 [cited 2018 Feb 25];26:85-8. Available from: http://www.educationforhealth.net/text.asp?2013/26/2/85/120699
| Context|| |
In a time of changing policy and healthcare delivery, it is critical for health professionals to consider how health literacy can and will impact health outcomes and health equity across the globe. Ratzan  noted that in 2009, the United Nations approved a Ministerial Declaration "stressing the need to enhance health literacy as an important factor in ensuring significant health outcomes through development of appropriate action plans." Since then, action plans to address health literacy have been developed in China, European countries, the United States (US), and in other areas around the world. Training and competencies of health professionals is an important priority in these plans, regardless of the country of origin.
Health literacy has been defined as "…that which allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate, and use information to make informed decisions."  Low or limited health literacy is found in a variety of individuals. It has been shown that certain variables may predict a person's general and health literacy levels. In the US, nonWhite ethnicity, low socioeconomic status, low education levels, and advanced age are potential risk factors for low health literacy.  Adults who struggle to understand written and verbal information are often embarrassed. Because of this, they will be less likely to ask for a more specific explanation from the health professional, which may lead to an overall lack of understanding. This gap in patient-provider communication is critical and potentially life-threatening for some patients. Many adults even struggle to fill out required forms for health services due to the unfamiliar terminology or complicated layout of the document. All told, low health literacy results in a wide array of negative outcomes for many individuals. Healthcare professionals have an obligation to meet patients in the middle, and to not rely solely on the patient's potentially limited health literacy skills.
A general lack of knowledge among healthcare providers regarding low health literacy can negatively impact patient-provider communication and deter effective medical care.  Due to the often ambiguous indications from patients, it can be difficult for healthcare providers to identify a patient with low health literacy. ,, About 4 years ago, Jukkala et al.  conducted a survey of 190 individuals who attended a university presentation on health literacy. Not surprisingly, 16% of the respondents reported that they had not heard of the term health literacy. Overall, participants were most knowledgeable about the relationship between education level and health literacy, and least knowledgeable about the prevalence of low health literacy. One participant even commented that health literacy "has nothing to do with my practice."
Given this seemingly pervasive issue in the US, the purpose of this study was to survey speech-language pathologists, audiologists, and students in Arkansas, a southern state in the US, on their knowledge of limited health literacy. What we learn from this survey may inform (1) academic and clinical training of health providers in the US and other countries and (2) result in efforts to bridge the health literacy and communication gap between providers and their patients.
| Methods|| |
Participants were recruited in one of two ways. First, professionals and students from two state audiology and speech-language pathology organizations were sent, through usual communications, an online link seeking their participation. The link was available for 2 weeks in 2011. Additional participants were recruited at the beginning of a formal presentation by the authors at a state convention. A total of 198 individuals participated: Speech-language pathologists (n = 132), audiologists (n = 42), and graduate and undergraduate students (n = 22). The study received prior institutional review board approval by the University of Arkansas at Little Rock.
Procedures and Data Analysis
A 10-question multiple-choice survey was constructed to identify discipline or student-discipline status (speech-language pathology or audiology), to query knowledge of limited health literacy impact on patients, and on the healthcare system. Some of the questions were adapted from the Limited Literacy Impact Measure instrument used by Jukkala et al.  One major change was our modification of the average US adult reading grade level from the 6 th to 8 th grade. We made this change based on the often-cited National Adult Literacy Survey conducted in 1992.  The online-based survey was set up using a SurveyMonkey.com account. The paper-and-pencil version of the survey was distributed during the convention presentation and collected before the session began. Prior to starting either online or paper-and-pencil based surveys, respondents received instructions not to search for their answers on their computer, tablet, or smartphone. All results were analyzed descriptively.
| Results|| |
[Table 1] presents our results. Respondents appeared to be most knowledgeable about how limited health literacy can cause minor health issues to become major ones (overall 99.5%) and how limited health literacy taxes and wastes resources from patient to provide in the healthcare system (overall 96.5%). Respondents also seemed to be fairly knowledgeable that a minimum of a high school education will not guarantee adequate health literacy (overall 78.6%) and that it is difficult to determine health literacy in patients on the basis of race or ethnicity, culture, age, or socioeconomic status (overall 88.8%). Respondents were least knowledgeable about the percentage of the US population that has difficulty with health-related reading materials (17.7%). There were little to no differences in the knowledge of speech-language pathologists, audiologists, and students. When compared with the overall results of Jukkala et al.,  the knowledge of this sample of respondents was at least as good as and sometimes better. The only exception is that our respondents answered 14% less correctly that a patient would be reasonably health literate with at least a high school education.
|Table 1: Percentage correct responses for knowledge of limited|
health literacy survey
Click here to view
| Discussion|| |
The survey revealed that there were little to no differences in the knowledge of these speech-language pathologists, audiologists, and students about low health literacy. However, as separate groups: Audiologists appeared to be more knowledgeable about the average US reading grade level, speech-language pathologists appeared to be more knowledgeable about the high reading grade level of current Health Insurance and Portability and Accountability Act (HIPAA) privacy forms designed to assure patients that their records will be protected and held confidential, and students appeared to be more knowledgeable about the reading grade level of consent forms. Above all, these respondents performed as well or better compared with a similar survey by Jukkala et al.  upon which this study's survey was based. The primary limitation of the study is its brevity and the manner in which the questions are asked. The survey only provides a superficial assessment of the knowledge of health literacy, but it does allow for some comparison with the Jukkala et al.  study. A longer survey with more questions that probe one's knowledge of health literacy would have been ideal. Nevertheless, that our findings were more or less comparable to the Jukkala et al.  study suggests adequate content validity. While not necessarily a limitation of the study, participants may have come from within the state or from out of the state both residentially and/or educationally, each of which can also influence the outcome of the study. Finally, the results from our study in Arkansas may not necessarily be generalizable to other areas in the US or across the globe. Increasing the awareness of health literacy and the impact of limited health literacy among all healthcare providers would be a worthwhile endeavor. Training institutions are ideal to prepare students for the workforce. Increasing health literacy knowledge and putting it into practice clinically will go a long way towards enhancing the culture of health care. Indeed, Roberts et al.  recently published a replicable model of a health literacy curriculum for use in their medical school program. An internet search has also revealed information about health literacy courses around North America and in European countries.
Health literacy is not just the patient's responsibility, but healthcare providers are called to meet patients in the middle and make reasonable adjustments.  We can learn important lessons from numerous other studies on health literacy. For example, older clients may experience low health literacy if hearing sensitivity, visual acuity, and/or cognitive processing is affected. McCarthy et al.  reported that although 71.6% of 755 older adults they studied had adequate health literacy skills based on a 50-item Test of Functional Health Literacy in Adults, only 40.5% correctly recalled when to take their gastroesophageal reflux disease pills from a standardized video. In another example, health professionals continue to struggle with the importance of patient health literacy skills. Macabasco-O'Connell and Fry-Bowers  reported of 76 nursing respondents that only 30% ever asked patients if they had reading difficulty, 80% never or rarely formally assessed patients' health literacy with a validated questionnaire, and, most troubling, 56% felt that limited health literacy is viewed as a low priority compared with other patient problems.
In summary, more work (education, clinical, and applied research) is needed to study health literacy in various patient populations and develop effective approaches to combat low health literacy in the field of communication sciences and disorders, as well as other healthcare disciplines, across the globe.
| Acknowledgements|| |
Portions of this work were presented at the 2012 American Speech-Language-Hearing Association convention in Atlanta, GA, and at the 2012 Jane H. LeBlanc Conference in Communication Disorders in Jonesboro, AR.
| References|| |
|1.||Ratzan SC. Global health: The path forward. J Health Comm 2010;15:111-3. |
|2.||Coleman C, Kurtz-Rossi S, McKinney J, Pleasant A, Rootman I, Shohet L. The calgary charter on health literacy: Rationale and core principles for the development of health literacy curricula. the centre for literacy of Quebec; 2008. Available from: http://www.centreforliteracy.qc.ca/Healthlitinst/Calgary_Charter.htm [Last retrieved on 2011 Apr 12]. |
|3.||White S. Assessing the Nation′s Health Literacy: Key concepts and findings of the National Assessment of Adult Literacy (NAAL). Chicago: American Medical Association Foundation; 2008. |
|4.||Macabasco-O′Connell A, Fry-Bowers EK. Knowledge and perceptions of health literacy among nursing professionals. J Health Comm 2011;16 Suppl 3:295-307. |
|5.||Rogers ES, Wallace LS, Weiss BD. Misperceptions of medical understanding in low-literacy patients: Implications for cancer prevention. Cancer Control 2006;13:225-9. |
|6.||Bass PF 3 rd , Wilson JF, Griffith CH, Barnett DR. Resident′s ability to identify patients with poor literacy skills. Acad Med 2002;77:1039-41. |
|7.||Jukkala A, Deupree JP, Graham S. Knowledge of limited health literacy at an academic health center. J Contin Educ Nurs 2009;40:298-302. |
|8.||Bastable SB. Literacy in the adult client population. In: Bastable SB, Gramet P, Jacobs K, Sopczyk DL, editors. Health professional as educator: Principles of teaching and learning. Sudbury, MA: Jones and Bartlett Learning; 2012. p. 1-55. |
|9.||Roberts DM, Reid JR, Conner AL, Barrer S, Miller KH, Ziegler C. A replicable model of a health literacy curriculum for a third-year clerkship. Teach Learn Med 2012;24:200-10. |
|10.||McCarthy DM, Waite KR, Curtis LM, Engel KG, Baker DW, Wolf MS. What did the doctor say? Health literacy and recall of medial instructions. Med Care 2012;50:277-82. |