Health Literacy Case Study

Karen has returned home from being in the hospital. She was experiencing vomiting, fatigue, and a drastic change in urination. After some testing, it was conclusive that she had a kidney infection. Karen was prescribed antibiotics and recommended to take a few days off. Karen goes to her local pharmacy to fill her prescription. At home, she attempts to take her antibiotics but is having difficulty understanding the intake instructions. The instructions state to take two pills orally daily. Karen questions does she take the pills together or one in the morning and one at night. Frustrated, Karen returns to the Emergency Room for assistance. Like Karen, in our scenario, many Americans have low health literacy skills. According to Davis et al
(2006), quoted from the Institute of Medicine's Report, A Prescription to End Confusion, "90 million adults in the United States have trouble understanding and acting on health information" (847). Those who are most impacted by health literacy are elders, minorities, low income individuals and those who have low English skills. (Wilson,2009). These individuals are impacted based upon the lack of educational opportunities.
Why should we focus on health literacy?
If there is low literacy then the ability to properly take vital medications efficiently is low as well. This could eventually impact an individual's overall health. Peterson et al. (2011) examine health literacy as it correlates to rehospitalization in patients that have had heart failure. It is discovered that through three brief screening questions, "low health literacy...is associated with higher mortality" (Peterson,2011,1700). There is a correlation between health literacy and hospitalization as well as emergency use. If the individual is a low literacy risk then their ability to determine if a health concern, for the individual or their child, is a true emergency or could be handled in their home may be difficult. According to the CDC (2012), approximately 18% of emergency visits were that of children 18 and younger. With the proper educational tools provided, this percentile has the ability to
decrease.
Researchers are using different instruments to get a better grasp on improving health literacy and providing a readability, the level in which an individual can understand what they have read, mark suitable for everyone. Researcher uses the literacy assessment, REALM-SF, to determine the appropriate literacy level for patient's educational materials. (Arozullah,2007). The assessment has individuals read 7 words and are assessed upon how many are read out loud correctly (I.e. 0 < 3rd ,1-3 4th –6th, 4-6=7th, 7> 9th) (Arozullah,2007). The researcher concluded test, REALM-SF, is simple, validated, and efficient (Arozullah,2007).
Several steps have been put into place to begin the journey of improving health literacy.
Cook created a book entitled " What to Do When Your Child Gets Sick" to help parents determine between true emergencies and the ones that could be handled at home. Cook reported a 40% increase in correct responses from pre-to post-test (Cook, 2013). Intervention method such as brochures has also been put into action. Davis et al. (1996) created brochure that was written at the 6th grade level, discussed that Polio Vaccine and was effective in comprehension (Dewalt, 2009). Classes and camps are also intervention taken in the past. Robinson et al (2008) held a two-hour literacy and asthma education class for asthmatic children and reported a drop from 63% to 33% in ER and hospitalization visits (Dewalt, 2009). Yin et al. (2008) took a different intervention approach. Yin et al. (2008) uses pictogram based instruction and teach back counseling to help parents give the proper dosage of liquid medication to their children (Dewalt, 2009). This approach showed improvement in medication preparation, use of standardized dosing instruments and fewer errors in dosing frequencies (Dewalt, 2009). Interventions bring a different approach to teaching as well as impact health
literacy.