Economic Considerations of Health Literacy

Roberta Pawlak


Nurs Econ. 2005;23(4):173-180. 

In This Article

Nursing Roles Affected by Health Literacy

Nursing has known the challenges of consumer barriers to health information and resources for decades. As care delivery and payer systems in the United States have become more complicated, the divide between those who can navigate systems to maintain their health, and those who can not, has widened. Care delivery systems have been created assuming that consumers can identify their needs and have the ability to receive, understand, prioritize, and access resources to meet them. The gap dividing consumers with needed care becomes greater with differences in language and culture. As care delivery systems become more complicated and technologically based, problems with health literacy continues to grow.

It is recognized that regardless of the nurse's employment role, there may be elements of leader, provider, educator, partner, and researcher in their responsibilities with health literacy. A suggested outline of nursing roles in health literacy issues can be found in Table 2. Regardless of how complicated or simple these roles are, a common theme that establishes a foundation for this interface is communication. The simplest of communication models (sender sends message to receiver and awaits feedback to confirm the message was received as intended) takes time. It is this simple model, however, that can guide nursing in modifying roles in health literacy issues.

Understanding literacy standards and regulatory guidelines is critical in professional practice, administrative roles, and political activism. Regulatory guidelines outline specific expectations to uphold patient rights, informed consent, educating patients and families, protecting consumers from risk, improving and maintaining benchmarks in safety and quality care, providing interpreter services, ensuring staff competence, and implementing staffing plans to meet patient's needs (Dreger & Tremback, 2002). JCAHO includes accreditation standards for patient and family education intended to guide teaching intervention to improve patient health outcomes and promote positive clinical outcomes (Brooks, 2001). In addition, safety standards can best be met if there is clear understanding of treatment modalities. It has been suggested that health service utilization by consumers is increased by low literacy ability (Andrus & Roth, 2002; Baker et al., 1997). This has facility and service planning, as well as significant cost control and budget implications, for nurse administrators. Health literacy also affects business relationships; whether outsourcing for services not offered directly by the "home" facility, or working with insurance companies to enhance consumer understanding of "covered" utilization decisions down to influencing the readability of coverage descriptions and managing the impact of the uninsured or underinsured populations. This applies, as well, to government documents, thus leading into the area of health communication and health policy.

For years nurses have been involved in various aspects of developing patient education materials, yet most nurses have not been taught how to do so (Monsivais & Reynolds, 2003). Practicing nurses need the opportunity to carefully and specifically investigate the role of health care literacy in producing positive client outcomes (Boswell, Cannon, Aung, & Eldridge, 2004; Schwartzberg, 2002). Preparing material that is readable and delivering it so that it is understandable is no small undertaking. Efforts to do so may be costly. We may find, however, the more understandable health information and health care systems are for patients, the closer the care is matched with need. This can result in a more efficient (and potentially less costly) delivery system.

Nurses do not work in isolation. Interdisciplinary planning and client health coordination are expectations in care delivery. To this end, coordination of resources both inside and outside of the formal care delivery setting is needed in response to health literacy issues. Community linkages, working with community groups, health ministry staff, and other networks in the system environment of a client's home are imperative in enhancing consumer understanding, integrating cultural values, improving system knowledge, and advocating for underserved or high-risk populations such as those who are illiterate (Wilson, Racine, Tekieli, & Williams, 2003).

Opportunities are vast in this area. As evidence-based practice has become an expectation in planning, prioritizing, and delivering care in this country, the Cochran Collaboration has been challenged to review consumer information, such as what is available on the World Wide Web (White, 2002). Although this avenue focuses on the methodology of randomized control trails, it needs to be complemented with a variety of studies that use both qualitative and quantitative Methods.


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