Researchers at Boston Medical Center assessed the impact of poor health literacy on the health outcomes of people with chronic diseases, with a special focus on the clinical care of patients with inflammatory bowel disease (IBD). Importantly, the researchers also identified deficiencies in medical training, and suggested communication strategies that could help clinicians better educate their patients.
The review study, “Understanding Health Literacy and its Impact on Delivering Care to Patients with Inflammatory Bowel Disease,” was published in the journal Inflammatory Bowel Diseases.
According to the Institute of Medicine, health literacy is as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Limited health literacy appears to be a problem for large numbers of people, and particularly impacts the management of chronic and typically complex diseases, such as IBD.
Previous studies have demonstrated an association between poor health literacy and limited disease knowledge, and poor health outcomes in chronic disease patients, such as an increased risk of hospitalization, increased mortality, and early readmission. It has also been shown that people with poorer health literacy are the least likely to make use of recommended healthcare screenings, preventive healthcare services, and physician visits.
Among patients with IBD, limited health literacy has been linked with lower vaccination rates, and lower pap smears and osteoporosis screening, conditions that have an increased incidence among the IBD population.
The research team highlighted that patient education and empowerment is extremely important in the complex decisions that IBD patients need to make, and should be a focus of healthcare providers, as limited health literacy leads to resistance to shared medical decision-making and lower levels of satisfaction. At the same time, researchers found a continuing lack of resources to educate patients, and advised that, instead of the more common and passive delivery of knowledge, the health community strive to create a more personal context for self-care, encouraging a patient’s critical and independent thinking.
The Crohn’s Disease Shared Decision Making Program was cited as an example of a medical decision aid that increases patients’ knowledge, encouraging them to participate in their own medical decisions.
Researchers also pointed to deficiencies in the education and training of community internal medicine residents, and noted that both residents and experienced clinicians often overestimate the health literacy of their patients. They encouraged the inclusion of health literacy concepts in physician training, and recommended communication strategies, such as the use of pictures and pamphlets, to encourage patients to ask questions and better ensure they understand the answers.
Clearly, an “unmet need for systems that reduce complexity, support providers and utilize educational tools in order to empower all patients, at all levels of health literacy, to engage in their care” exists, the study’s lead author, Lauren K. Tormey, MD, said in a press release.