Health literacy is the ability to obtain, process, and understand information and services to make health decisions. In the midst of a rapid expansion of medical knowledge and technology, many patients do not have the resources to actively engage in their own care and efficiently access and navigate the healthcare system (1). 

Limited health literacy is an issue that isn’t always visible and raises varying opportunities. Many patients are not familiar with medical terms or how their bodies work. Some struggle to interpret numbers or risks to make informed decisions, while others have complex conditions that contribute to anxiety and despair and in the midst of a complicated self-care routine. Even common health tasks, such as keeping up with immunizations and following directions on a prescription drug label, can feel overwhelming to some patients. 

Among patients seeking specialty care, those with lower health literacy spend less time with the clinician and ask fewer questions (2). The patients that would seem to benefit the most from health education and counseling actually receive less as suggested by the shorter duration of office visits (3). 

In a recent survey, limited health literacy was associated with certain factors among patients seeing a hand surgeon, such as advanced age, lower income, and being publicly insured or uninsured (4). It should also be noted that while Hispanic patients often face language barriers in the clinical setting, it was found that a patient’s primary language has less influence on symptom intensity and magnitude of disability than psychological distress and less effective cognitive coping strategies (5). Interventions to reduce pain interference and improve communication strategies should be considered in patients of all nationalities.

Limited health literacy is a barrier to effective patient engagement in healthcare. In the increasingly tangled health-information environment, it is important to actively involve patients with limited health literacy in the decision-making process by encouraging question-asking, particularly given that most test and treatment options are preference-sensitive (2). Instead of assuming that patients are absorbing and understanding all of the information they are told, physicians might consider what is sometimes referred to as “universal precautions” when sharing important knowledge regarding health and treatment. 

Our research on health literacy is focusing on several areas:

1. Characterizing the relationship between health literacy and question-asking behavior during outpatient office visits.
2. Utilizing decision-support tools intended to benefit diverse patients. These tools help people become aware of what matters most to them (their values) and reorient them to the most accurate current information. The goal is choices consistent with their values and not based on misconceptions or clinician biases and incentives. 
3. Assessing if there is a correlation between health literacy and total time spent seeking hand surgery care (1).
4. Addressing health disparities related to differences in health literacy among patients, including race, age, and socioeconomic status. 
5. Encouraging providers to simplify messages and improve communication strategies, especially when interacting with the elderly and disadvantaged. 
6. Anticipating deference related to health literacy and developing strategies for eliciting questions and ensuring the understanding of all patients.

References

1. Alokozai A, Bernstein DN, Sheikholeslami N, Uhler L, Ring D, Kamal RN. Impact of Health Literacy on Time Spent Seeking Hand Care. Hand (N Y). 2017 May 1:1558944717708027. Doi: 10.1177/1558944717708027. [Epub ahead of print] PubMed PMID: 28513193.
2. Menendez ME, van Hoorn BT, Mackert M, Donovan EE, Chen NC, Ring D. Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons. Clin Orthop Relat Res. 2016 Oct 28. [Epub ahead of print] PubMed PMID: 27796802.
3. Menendez ME, Parrish RC 2nd, Ring D. Health Literacy and Time Spent With a Hand Surgeon. J Hand Surg Am. 2016 Feb 13. pii: S0363-5023(16)00107-6. doi:10.1016/j.jhsa.2015.12.031. [Epub ahead of print] PubMed PMID: 26880496.
4. Menendez ME, Mudgal CS, Jupiter JB, Ring D. Health Literacy in Hand Surgery Patients: A Cross-Sectional Survey. J Hand Surg Am. 2015 Mar 4. pii:S0363-5023(15)00047-7. doi: 10.1016/j.jhsa.2015.01.010. [Epub ahead of print] PubMed PMID: 25746142.
5. Menendez ME, Eberlin KR, Mudgal CS, Ring D. Language barriers in Hispanic patients: relation to upper-extremity disability. Hand (N Y). 2015 Jun;10(2):279-84. doi: 10.1007/s11552-014-9697-8. PubMed PMID: 26034444; PubMed Central PMCID: PMC4447666.