Context Patients with the greatest health care needs may have
the least ability to read and comprehend information needed to function
successfully as patients.
Objective To examine the scope and consequences of poor health
literacy in the United States, characterize its implications for
patients and physicians, and identify policy and research issues.
Participants The 12 members of the Ad Hoc Committee on Health
Literacy, American Medical Association Council on Scientific Affairs,
were selected by a key informant process as experts in the field of
health literacy from a variety of backgrounds in clinical medicine,
medical and health services research, medical education, psychology,
adult literacy, nursing, and health education.
Evidence Literature review using the MEDLINE database for January
1966 through October 1, 1996, searching Medical Subject Heading (MeSH)
reading combined with text words health or
literacy in the title, abstract, or MeSH. A subsequent search
using reading as a search term identified articles published
between 1993 and August 1998. Authors of relevant published abstracts
were asked to provide manuscripts. Experts in health services research,
health education, and medical law identified proprietary and other
Consensus Process Consensus among committee members was reached
through review of 216 published articles and additional unpublished
manuscripts and telephone and Internet conferencing. All committee
members approved the final report.
Conclusions Patients with inadequate health literacy have a
complex array of communications difficulties, which may interact to
influence health outcome. These patients report worse health status and
have less understanding about their medical conditions and treatment.
Preliminary studies indicate inadequate health literacy may increase
the risk of hospitalization. Professional and public awareness of the
health literacy issue must be increased, beginning with education of
medical students and physicians and improved patient-physician
communication skills. Future research should focus on optimal methods
of screening patients to identify those with poor health literacy,
effective health education techniques, outcomes and costs associated
with poor health literacy, and the causal pathway of how poor health
literacy influences health.