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Caring for Limited-English Proficient Patients with Low Literacy

A patient and provider smiling while having a conversation

Health literacy ensures that patients not only get the care they need but also understand their diagnosis and treatment plan.  Health literacy is broadly defined as a person's ability to:

  • Seek out and find accurate, reliable health information
  • Read and process the information they find
  • Utilize the information to make appropriate healthcare decisions

Unfortunately, only about 12% of adults in the U.S. have "proficient" health literacy skills, another 53% have intermediate literacy, and as many as 36% — more than one in three people — have health literacy at the "basic" or "below basic" level.

Low health literacy disproportionately affects:

  • Older adults
  • People with low income or low socioeconomic status
  • Medically underserved communities
  • Underrepresented groups, including those with limited-English proficiency (LEP)

Low Literacy Among Limited-English Speakers

When hospitals and providers implement programs to expand accessible care for limited-English speaking patients, it's important to understand the extent of low health literacy. One study examining various social determinants of health found that LEP patients were four to five times more likely to need health literacy assistance than English-proficient populations. The percentage of adults with basic or below basic health literacy among Hispanics (65%) is more than twice as high as Whites (28%).

It's important for healthcare providers and facilities to understand the different ways patients obtain and analyze health information. Some patients — especially those with higher health literacy — can read written information such as handouts or digital resources to learn more about diagnoses and treatments. But most low-health-literacy patients are far less likely to use print or digital resources.

Only 15% of adults with below basic literacy sought out and used information from the internet on health topics. By contrast, 62% of proficient health literacy patients use these resources. This demonstrates why a translated written document or a referral to a website with information about an LEP patient's diagnosis might not be enough.

Implications of Low Literacy on Health

Low health literacy is often difficult to see. Many people who come to a doctor's office or hospital find ways to avoid the shame or embarrassment of not being able to read and understand information about their care.

Medical terminology and information are complex, even for people who have a high level of understanding. Getting diagnosed with a serious illness or a complex condition can add to that anxiety, especially for someone who doesn't clearly understand medical terminology or how their bodies work. All of this complicates a patient's ability to make informed decisions about their care.

Someone with low health literacy is more likely to:

  • Experience medication errors, including dosing or schedule errors
  • Be noncompliant with medications or treatment plans
  • Visit the emergency room for non-emergency care
  • Have complications when managing chronic health conditions
  • Be readmitted to the hospital after discharge
  • Experience longer hospital stays
  • Misunderstand information during a public health emergency

Low health literacy contributes to more medical errors, increased rates of illness and disability, and lost wages that add up to more than $236 billion a year.

Creative Ways to Engage With Patients

When providers identify patients with low health literacy, it's essential to find creative ways to engage with them for a better overall care experience and better outcomes. While it can be difficult to identify the people who come to a clinic with low health literacy, you can look for signs like:

  • Inability to complete written registration forms
  • Inability to name their medications, dosage, or the purpose of taking them
  • Poor ability to recall information about their medical history or treatment
  • Frequently missed appointments
  • Excuses to avoid reading written materials, such as forgetting reading glasses or being too tired to read the information

To help LEP patients with low literacy feel more comfortable, every clinic should have medically qualified interpreters available to communicate with the patient verbally. Having written material translated to the patient's native language is still important, but providing real-time verbal translation (not just interpretation) will ensure that even low-literacy patients get the information they need.

Providers and clinical staff should also:

  • Provide translators at check-in and check-out to help fill out the required paperwork
  • Listen carefully to the information that a patient shares through a translator about their health and concerns
  • Pay attention to nonverbal cues that indicate a person might not fully understand the information they are receiving
  • Work with translators who understand both the person's language and culture

Help Your LEP Patients Get the Care They Need

Once you identify LEP patients with low health literacy, the next step is to help them get the resources they need for better care outcomes. Download our guide, Designing Your Ideal Language Access Plan, to learn how a qualified language service provider like GLOBO can help.

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