Health literacy in the urgent care setting: What factors impact consumer comprehension of health information?

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Health literacy is the degree to which individuals can obtain, process, understand, and communicate about health information needed in order to make informed healthcare decisions (Berkman, Davis, & McCormack, 2010). Approximately 30% of the general U.S. adult population have limited health literacy (Nielson‐Bohlman, Panzer, & Kindig, 2004). This is less than what is reported among the emergency department (ED) and primary care patient populations. Limited health literacy rates in ED populations range from 7% to 74% (Brice et al., 2008; Ginde, Weiner, Pallin, & Camargo, 2008; Olives, Patel, Patel, Hottinger, & Miner, 2011; Schumacher et al., 2013). Limited health literacy among adults seen in EDs is associated with increasing age (Downey & Zun, 2008; Ginde et al., 2008; Olives et al., 2011), male sex (Olives et al., 2011; Schumacher et al., 2013), lower education level (Ginde et al., 2008), and lower income (Ginde et al., 2008). Herndon, Chaney, and Carden (2011) evaluated 31 studies that measured health literacy in an ED setting and concluded that collectively across the studies, approximately 40% of the adults seeking care had limited health literacy.
Similar to the ED population, limited health literacy has been reported in 14.5% to 65% of patients assessed in primary care settings (Heinrich, 2012; McNaughton, Jacobson, & Kripalani, 2014; Weiss et al., 2005; Willens, Kripalani, & Schildcrout, 2013). In addition to association with increased age, male sex, and lower levels of education and income, limited health literacy of primary care patients is also associated with negative health outcomes, such as higher likelihood of hospitalization (Fleisher, Shah, Fitts, & Dahodwala, 2016) and uncontrolled blood pressure (McNaughton et al., 2014). Adults with limited health literacy are more likely to be overweight, have inadequate exercise habits (Joshi et al., 2014), be nonadherent to asthma treatment regimens, demonstrate poor techniques in the use of asthma inhalers (Federman et al., 2014), have less diabetes‐related knowledge (Bailey et al., 2014), have less knowledge about heart failure, and have lower performance of self‐care behaviors (Macabasco‐O'Connell et al., 2011).
The evolution of the patient–provider relationship from a traditional paternalistic model to a more collaborative approach supports a more active role for patients (Ishikawa & Yano, 2008). Patients are encouraged and expected to engage in the decision making process with their healthcare providers (Anker, Reinhart, & Feeley, 2011; Ishikawa & Yano, 2008). An understanding of expected self‐management may be of even greater significance for patients seeking care in an urgent care (UC) setting, where return visits for follow‐up care to reinforce expectations are not routine. In order for patients to effectively participate in shared decision making and health self‐management, they need to be able to obtain, understand, communicate about, and apply health information. Additionally, the ability to access and navigate the healthcare system is needed. These skills collectively reflect adequate health literacy (Berkman et al., 2010). Health literacy is a significant predictor of a patient's health status above and beyond level of education, race, employment, and income (Nielson‐Bohlman et al., 2004). Limited health literacy is associated with poor health outcomes (Federman et al., 2014; Joshi et al., 2014; McNaughton et al., 2014). With an estimated 90 million American adults lacking adequate health literacy skills (Nielson‐Bohlman et al., 2004), it is imperative that healthcare providers in UC settings recognize and mitigate the associated challenges to ensure optimal outcomes of care.
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