Although my training and education as an occupational therapist (OT) included the concept of health literacy as an essential element of therapeutic intervention, the realization of just how important health literacy is hit me most significantly when I was working as a home care therapist.

Going Home Is Challenging

After a hospital stay, patients may spend time in rehab or assisted living facility. However, most patients eventually return home. Even though it’s a positive step to be able to return to your own home, it’s undeniably a difficult journey. There are so many adjustments necessary to function safely and independently in the home setting.

Here are just a few examples:

1. Managing changes in medications. Often the challenges of going off post-surgical pain medications intensify the difficulties.
2. Learning how to put on and take off various types of braces and slings.
3. Understanding complex discharge instructions, such as medication changes, when to call the doctor’s office, and how to prevent infection.
4. Being able to prepare one’s own meals, bathe, dress, and use the toilet. This is particularly difficult after acquiring cognitive deficits due to a stroke or other type of brain injury.

Even if patients are fortunate enough to have a dependable and caring support system, those supports share in the difficulty of keeping their loved one as safe, healthy, and independent as possible.

Health Literacy Affects Hospital Readmissions

It’s been well documented in scholarly literature that impairments in health literacy are a key factor in hospital readmissions. A recent study included an analysis of 7,773 Medicare claims on patients who experienced acute myocardial infarction. Results indicated that low health literacy skills were a significant independent predictor of 30-day hospital readmissions. The authors described health literacy as a modifiable risk factor.^[1] In essence, then, these hospitalizations that are so disruptive to people’s lives and financially draining for families as well as the healthcare system are to large extent preventable.

Patient Health Literacy Is Hard to Assess

Unfortunately, it’s hard for healthcare professionals to assess their patients’ health literacy. Moreover, healthcare professionals may overestimate their patients’ health literacy skills. For instance, a study looked at nurses who misjudged their patient’s level of health literacy. It found that nurses who overestimated health literacy skills outnumbered those who underestimated health literacy skills by a margin of six to one. There was also some indication that health literacy did not correlate with education levels.^[2]   Considering these results, it might be wise to explore whether similar problems exist in the other healthcare professions.

Our Task as OT Practitioners

According to the American Occupational Therapy Association, OT practitioners have a strong role to play in helping our patients to both improve their personal health literacy, as well as overcome barriers caused or exacerbated by low health literacy. We know that as we provide therapeutic interventions that assist our patients in becoming more independent, safe, and satisfied with their daily function, we must do everything we can to improve their personal health literacy. In the words of Healthy People 2030, we must ensure that they can effectively “…find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” [para. 4]^[3],[4]

Similarly, as healthcare professionals, we are called to improve our organizational health literacy. In other words, we must “equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” [para 5] ^[5] This includes using health literate approaches, such as creating materials and using communication strategies that enhance our patients’ abilities to participate in health-related activities. The result is the nurturing of a more health-literate society.^[6],[7]

In Sum

The OT focus on work, play, and activities of daily living (ADLs) is inherently connected with the facilitation of a health literate society. This greatly benefits our individual patients, as well as the over-burdened healthcare system as a whole. As we work with our patients (whether in-home care, outpatient, inpatient rehab, etc.), we must be always cognizant of their current level of health literacy. Furthermore, we must continue to explore with our colleagues and employers how we can improve organizational health literacy.

Additional Resources to Check Out

• The Power of Good and Bad Information, Barbra Kingsley
• Personal Health Literacy Measurement Tools, AHRQ

References