Limited Health Literacy: The Impact on Adherence

Désirée Lie, MD


March 29, 2011

Why Is Your Patient Not Adhering to Treatment?


Case 1. Michelle is a high-school graduate and 21-year-old single mother of a 1-year-old child. She works as a cashier at a local grocery store and lives with her parents. Her son was up much of the night crying and, distraught, she brought him to her healthcare provider in the morning. He is diagnosed with acute otitis media and Michelle is given a prescription for liquid antibiotics to be administered 3 times daily. Michelle reads the instructions on the medication bottle, which state: "Using the spoon provided, give the patient half a teaspoon of this medicine 3 times a day." Michelle dutifully fills half a teaspoon and pours the medication into her child's painful ear.

Case 2. Mrs. Smith is a 60-year-old widower and retired school teacher who lives alone and is visited by her son and daughter, who live across town, once a week. After a physical examination that included normal breast and pelvic examinations, a mammogram is recommended. Mrs. Smith has a friend who was recently diagnosed with breast cancer after finding a breast lump during a self-exam. Because Mrs. Smith had not found a lump in her breasts and had been told her breast examination was normal, she decided not to show up for her mammogram and did not discuss this further with her provider.

Case 3. Mr. Cruz is a 50-year-old store manager with type 2 diabetes. He now requires insulin, having failed oral therapy and dietary measures. He is referred to his diabetes health educator who demonstrates how to inject insulin by using the needle and syringe on an orange. Mr. Cruz's blood glucose levels remain poorly controlled over the following month. On careful direct enquiry about how he is injecting his insulin daily, his provider discovers that he has been injecting insulin into oranges and eating the oranges daily.

What do these cases have in common as sources of poor adherence or medical errors, and what strategies or routine practices by providers may have prevented the unexpected or adverse outcomes?

Questions to Consider

  • What are the likely profiles of patients with low health literacy (HL)?

  • What are the most appropriate ways of recognizing different levels of HL in patients?

  • What are some effective practice strategies for closing the health literacy gap that are most likely to lead to improved patient adherence and healthcare quality?


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