Health illiteracy has become an issue of concern worldwide. Several organisations in the US such as the Institute of Medicine, American Medical Association, National Institute of Health, and Department of Health and Human Services (HHS), have promoted health literacy as a research priority.

People with poor health literacy may have difficulty understanding instructions or prescriptions on drug bottles, medical education brochures and navigating through complex healthcare systems. A study has shown that people with poor health literacy are at higher risk of visiting the emergency room, being hospitalised, and in the worst of cases, even death.

Separately, a survey concluded that poor health literacy is to be expected among the elderly, minority populations, patients with low socioeconomic status, and medically underserved people. It is important to note the causes of this issue so that actions can be tailored accordingly.

Use of medical jargon

The use of medical jargon or complicated medical terminologies among doctors may compromise a patient’s understanding. This situation is more apparent in patients with limited English proficiency.

Health workers must note that even a native English-speaking patient may also have difficulties in understanding medical terminology. Physicians should explain such medical terminologies even if a patient is considered to have a higher educational background.

Low educational skills

People with low educational background may have inadequate basic knowledge to understand medical instructions and navigate through complex healthcare systems. Several studies have demonstrated a strong association between lower educational level and poorer health outcomes. Researchers had put forward health literacy as a potential pathway that explained this strong relationship.

Cultural barriers

The Joint Commission, an independent and non-profit organisation centered in the US, recognised cultural barriers as one of the three threats to effective medical communication. Culture refers to the learned, shared and transmitted knowledge of values, beliefs, and lifeways of particular groups that are transmitted intergenerationally, influencing thoughts, decisions, and actions in patterned, or in certain ways.

Cultural barriers may differ according to country. For example, in Malaysia, insulin is believed to be a harmful substance. A study among healthcare professionals in Malaysia even found that there are diabetic patients that believed that an insulin therapy can be lethal.

Limited English proficiency

English is considered as a universal language of medicine. In fact, any university that provides a degree in medicine will enlist English proficiency as one of the requirements. For that fact, a patient with limited English proficiency may have difficulty in perceiving medical knowledge.

A survey has shown that 44% of Americans fall into the “intermediate” level of prose literacy. That is, they can apply information from moderately dense text and make simple inferences. This number may decrease prominently in the non-English speaking country.

Various disabilities

Disabilities such as cognitive decline and learning disabilities may be associated with lower health literacy. A cognitive decline can be found in the elderly which affects the ability to memorise or remember a prescription, and their reasons in making health decisions — that in turn, affect health literacy performance.

This relation can be observed in a study done in North America, which found that over half of all adults aged over 65 years have low health literacy. Needless to say older people usually have more than one medical condition that may further require them to have better health literacy abilities. MIMS

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