Patient–physician communication Drug labeling medical instructions and medical compliance Health information publications and other resources Informed consent Responding to medical and insurance forms Giving patient history Public health training Assessments for allied professional programs, such as social work and speech-language pathology

It is alarming that these skills and strategies are absent in more than half of the U.S. population. This fact is more disturbing when one considers that these are the very skills and strategies that often lead to longer life, improved quality of life, reduction of both chronic disease and health disparities, and cost savings. Health literacy is estimated to cost $106 billion to $238 billion annually (National Network of Libraries of Medicine, 2014).

According to the Agency for Healthcare Research and Quality (AHRQ), low health literacy is linked to higher risk of death and more emergency room visits and hospitalizations. Health literacy may not be related to years of education or general reading ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment (National Network of Libraries of Medicine, 2014).

The National Assessment of Adult Literacy (NAAL) measures the health literacy of adults living in the United States. Health literacy was reported using four performance levels: Below Basic, Basic, Intermediate, and Proficient. According to the NAAL, approximately 36% of adults in the United States have limited health literacy: 22% have Basic and 14% have Below Basic health literacy. An

additional 5% of the population is not literate in English. Only 12% of the population has a proficient health literacy level (National Network of Libraries of Medicine, 2014).

Here are some tips for working with people with low literacy:

Speak Slowly and Clearly: Not Loudly.

Repeat if Necessary: Make it clear at the outset that you are happy to repeat anything you say in conversation.

Avoid Acronyms, Idioms, and Abbreviations: The medical culture has a language of its own that includes many acronyms such as ED, HMO, and NPO. Take the time to say words the long way and avoid terms that will create confusion for non-native speakers. It is best when setting appointments to say “ eight o’clock in the morning” instead of “ 8 a.m.” Common expressions and idioms also can block communication. If you say “ I’ll run that past the doctor,” a patient with limited English proficiency may literally picture you running to the doctor, which sounds urgent when you intended a casual tone.