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AHA: Health literacy critical in CVD prevention
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Improvements in health literacy may help patients understand their CVD diagnosis and treatment, according to a scientific advisory from the American Heart Association published in Circulation.
“The opportunities for communication failure by health care providers who treat people for heart disease risk factors, heart diseases and strokes are rampant,” Jared W. Magnani, MD, MSc, FAHA, associate professor of medicine in the division of cardiology at University of Pittsburgh and chair of the writing committee, said in a press release. “Many patients do not understand the written materials they receive as part of health care or do not have the numeric skills to understand quantitative information. Also, medical care uses a considerable amount of specialized terminology, which some call jargon.”
Health literacy in U.S.
In 2003, the National Assessment of Adult Literacy Survey found that 36% of adults in the U.S. had basic or below-basic health literacy. Since then, health literacy now includes skills to function in an electronic, information-based society, according to the scientific statement. It also extends outside the hospital or clinic setting to focus on how patients navigate health-related experiences and self-care. Racial and ethnic minorities, those with less education and older adults are more likely to have limited health literacy.
“Health literacy both is related to and perpetuates the disparities associated with social determinants of health,” Magnani and colleagues wrote.
The obstacles that people with limited health literacy face to receive optimal health care include access to health care services and even paperwork to apply for insurance coverage, which typically exceeds the reading ability of an average adult from the U.S., according to the scientific statement. Patients with limited health literacy also have to overcome barriers regarding patient-provider communication, even with a growing emphasis on improving communication skills while providers are in medical school and residencies.
Health literacy is important to understand the information given by health care providers on primary and secondary prevention of CVD, the authors wrote, noting that recognizing hypertension and the ability to control it requires health literacy.
Improving medication adherence may be done through patient-centered interventions in those with limited health literacy, in addition to updated drug labeling, smartphone-activated videos and flashcards, according to the authors.
“Community-based interventions can leverage resources such as neighborhood pharmacies to promote blood pressure screening, monitoring and adherence,” Magnani and colleagues wrote. “Multifaceted interventions that incorporate patients, providers and health systems are essential to address health literacy barriers and to promote patient empowerment and success with long-term hypertension management.”
Other conditions and events that can benefit from improved health literacy include diabetes, obesity, CHD, congestive HF, stroke and atrial fibrillation. It can also influence positive lifestyle changes.
Tools to improve literacy
Ways to improve health literacy can be found in the Agency for Healthcare Research and Quality (AHRQ) Universal Precautions Toolkit for Health Literacy, which is consistent with the universal precautions approach.
“Fundamentally, health care providers who listen, speak slowly, use nonmedical language, encourage questions, apply teach-back methods and integrate the use of graphics or models are creating a culture of patient care that is sensitive to health literacy,” Magnani and colleagues wrote.
These improvements can also benefit with medication adherence, adequate self-care and even participation in clinical trials.
Technology such as mobile apps may benefit patients with limited health literacy, although inconsistent internet connections and not being able to afford a smartphone may prevent them from accessing these tools.
“Inadequate health literacy is a barrier that will need to be overcome to fulfill the mission of cardiovascular health across the spectrum of prevention, screening and treatment,” Magnani and colleagues wrote. “The public health effectiveness of cardiovascular treatments that have demonstrated efficacy in clinical trials cannot be realized without managing the issue of health literacy. Further work on health literacy in patients with or at risk for CVD should therefore focus on effectively addressing the adverse health impact of limited health literacy.” – by Darlene Dobkowski
Disclosures: Magnani reports no relevant financial disclosures. Please see the scientific statement for all other authors’ relevant financial disclosures.
Perspective
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Pamela Peterson, MD, MPH/MSPH
The major takeaways are that low health literacy is prevalent and has a significant impact on health status, health outcomes and health care costs. Given this, the statement calls for greater recognition and implementation of strategies to reduce barriers on a universal level. The statement also highlights the role of the AHA in raising awareness, incorporating health literacy in curricula, scientific statements and supporting further research around health literacy. It is great that AHA is taking this role given the importance of health literacy in the prevention and management of CVD on individual and community levels.
The statement outlines the components of the Health Literacy Universal Precautions Toolkit and also provides potential solutions at the organizational and community level.
The concept of universal precautions is useful. While sociodemographic characteristics are correlated with low health literacy, it is not always apparent who has low health literacy. Clinicians and health care systems should use best practices (such as in the Universal Precautions Toolkit) to improve access, communication and understanding among all patients.
One area of particular importance is in the use of technology. Technology has the potential to reduce barriers and improve outcomes for those with low health literacy. However, potential also exists to exacerbate disparities with increased use of electronic patient portals and internet-based health tools, which may present greater complexity for some patients. Future research should evaluate how different types of technology are used among patients with differing levels of health literacy and their effect on outcomes.
While the use of the Health Literacy Universal Precautions Toolkit is generally good in principle, it is also important to take into consideration other sociodemographic and cultural factors. Interventions that are community-centered or tailored to different cultural and sociodemographic groups may be more effective. Examples of such interventions are provided in the statement (eg, improving knowledge of stroke signs and symptoms using hairstylists in predominately black populations).
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