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Fortunately, proper educational techniques (Table 8.3) can make a difference in health care for people with low health literacy.¹² Of 111 patients with poorly controlled diabetes, 55% had literacy levels at the sixth‐grade level or below. Over the six‐month study period, patients with low and high literacy had similar improvements in A1C when they received one‐to‐one education and medication management using techniques that did not require high literacy from clinic‐based pharmacists. Among community‐dwelling Korean older adults, limited health literacy was associated independently with higher rates of chronic medical conditions and lower subjective health status. Nurses were found to be key to providing health education to these older adults²⁵ to help them maintain their independence. The greatest potential barrier to addressing health literacy is that most patients are often unwilling to admit that they have literacy problems.¹⁴ Indeed, Weiss, et al. found that 97% of their research subjects, regardless of literacy level, reported that television was their primary source of information.²⁰

Table 8.3 Educational techniques to improve health literacy.

Source: Based on Rothman, et al.¹².

Written materialIs age appropriateUses simple wordsIs at a sixth‐grade levelIn the primary language of the patientIncludes pictures and illustrationsPresents a small amount of information Auditory materialDelivered slowlyIs delivered one‐on‐oneIs delivered by a trusted providerIs in the patient’s primary language

Table 8.4 Cultural factors that affect health care.

AgeGenderEthnicityAssimilationGeneration cohortThe ever‐changing nature of culture