Health literacy refers to the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions (U.S. Department of Health and Human Service [HHS], n.d.). Health literacy skills include reading, writing, numeracy, communication, and electronic technology use (Hersh, Salzman, & Snyderman, 2015). Remarkably, between one-third and one-half of all US adults have limited health literacy skills (Yin, Jay, Maness, Zabar, & Kalet, 2015). Non-Whites have more often poor health literacy than Whites (Nair, Satish, Sreedharan, & Ibrahim, 2016). A systematic review of Mantwill, Monestel-Umaña, and Schulz (2015) explored that health literacy as a mediator between racial/ethnic disparities and self-reported health status, chronic disease management, preventive measures, and medication management. This study concluded that health literacy might explain some of the health disparities which combined with other socioeconomic factors, such as income or education. The victims of social disparities experience worse health outcomes, are also more likely to have inadequate health literacy (Mantwill et al., 2015).

Health literacy is essential to navigate the healthcare system and to make decisions about one’s health care (DeNisco & Barker, 2016). Patients with low health literacy increase the risk of poor health care system utilization due to a lack of health knowledge and useful resources (Levy & Janke, 2016; Mantwill & Schulz, 2017; Polster, 2018). Meanwhile, insufficient health literacy skills are associated with a high rate of hospitalization, poor health status, high healthcare cost and adverse psychological effect (HHS, n.d.). Those with low health literacy cost $3,892 more in annual health expenses than those showing good health literacy (MacLeod et al., 2017). Currently, I am working in an adult inpatient psychiatric unit. One of my patients, she was prescribed mood stabilizer Lithium to treat bipolar disorder. Despite providing medication education and advice upon discharge, she did not follow up with outpatient psychiatrists and didn’t recognize any sign of adverse effects. She ended up to return to the hospital for lithium toxicity treatment. I also work in our Crisis Responsive Center (CRC) as needed. CRC receive referrals from various sources, such as therapists, social workers, private psychiatrist, family, friends who have a mental health concern about the people. We assist in connecting the patients to various inpatient or outpatient mental health treatment facility. However, the patients we see may refuse our services, as long as they are alert, oriented, and in no mental health distress or a danger to themselves or others. If any patient fits any of the criteria mentioned, then psychiatrists have the authority to remove them involuntarily and send them to a hospital. Unfortunately, many people have minimal health literacy of mental disorders and antipsychotic drugs, and I frequently saw they refuse to get help from us. Some patients thought the mental health issue meant they were crazy and weak. Mental health literacy significantly influences help-seeking behavior (Gorczynski, Sims-schouten, Hill, & Wilson, 2017). Interventions to enhance outcomes related to health literacy are needed.

In my unit, we use Mini Mental Status Exam (MMSE) as health literacy assessments which test a range of everyday mental skills. The MMSE was found to have moderate to high convergent validity with the present health literacy measures (Dahlke, Curtis, Federman, & Wolf, 2014). Our psychiatrists conduct MMSE for every new admission.  After the assessment, psychiatrists, therapists, social workers, and nurses involved patients to choose health topics and develop an individual learning plan. I do my best to provide understandable and accessible information to patients. For example, sometimes I broke down instructions into small concrete parts or drew vivid pictures to explain the signs and symptoms of medications side effects. In CRC, we let charplin and interpreter involved to address the specific religious need and language barrier to explain the disorders and the need for treatments better. As a caregiver, I have the responsibility to understand the relationship between health literacy and healthcare outcome. Identifying health literacy levels is a challenging but meaningful step to provide empathetic care and bridge the gap.

References

• Dahlke, A. R., Curtis, L. M., Federman, A. D., & Wolf, M. S. (2014). The mini mental status exam as a surrogate measure of health literacy. Journal of General Internal Medicine, 29, 615-620. doi:10.1007/s11606-013-2712-x
• DeNisco, S., & Barker, A. M. (2016). Advanced practice nursing essential knowledge of the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning.Gorczynski, P., Sims-schouten, W., Hill, D., & Wilson, J. C. (2017). Examining mental health literacy, help seeking behaviours, and mental health outcomes in UK university students. The Journal of Mental Health Training, Education and Practice, 12, 111-120. doi:10.1108/JMHTEP-05-2016-0027
• Hersh, L., Salzman, B., & Snyderman, D. (2015). Health literacy in primary care practice. American Family Physician, 92(2), 118-124.
• Levy, H., & Janke, A. (2016). Health literacy and access to care. Journal of Health Communication, 21, 43-50. doi:10.1080/10810730.2015.1131776MacLeod, S., Musich, S., Gulyas, S., Cheng, Y., Tkatch, R., Cempellin, D., . . . awkins, K. (2017). The impact of health literacy on health outcomes among older adults. Innovation in Aging, 1, 833-834. doi:10.1093/geroni/igx004.3004
• Mantwill, S., Monestel-Umaña, S., & Schulz, P. J. (2015). The relationship between health literacy and health disparities: A systematic review. PloS One, 10. doi:10.1371/journal.pone.0145455
• Mantwill, S., & Schulz, P. J. (2017). Low health literacy and healthcare utilization among immigrants and non-immigrants in switzerland. Patient Education and Counseling, 100, 2020-2027. doi:10.1016/j.pec.2017.05.023
• Nair, S. C., Satish, K. P., Sreedharan, J., & Ibrahim, H. (2016). Assessing health literacy in the eastern and middle-eastern cultures. BMC Public Health, 16, 831. doi:10.1186/s12889-016-3488-9
• Polster, D. S. (2018). Confronting barriers to improve healthcare literacy and cultural competency in disparate populations. Nursing, 48, 28-33. doi:10.1097/01.NURSE.0000547717.61986.25U.S. Department of Health and Human Service. (n.d.). Quick guide to health literacy face sheet. Retrieved from https://health.gov/communication/literacy/quickguide/quic kguide.pdf
• U.S. Department of Health and Human Service. (n.d.). Quick guide to health literacy. Retrieved from https://health.gov/communication/literacy/quickguide/quickguide.pdf
• Yin, H. S., Jay, M., Maness, L., Zabar, S., & Kalet, A. (2015). Health literacy: An educationally sensitive patient outcome. Journal of General Internal Medicine, 30, 1363-1368. doi:10.1007/s11606-015-3329-z