Navigating the U.S. health-careand public health delivery systems is a complex task with numerous layers of bureaucracy, procedures, and processes. Consequently, an adult’s ability or inability to navigate these systems may reflect systemic complexity as well as individual skill levels. Patients, clients, and their family members are typically unfamiliar with these systems and the associated jargon. Even highly educated individuals may find the systems too complicated to understand, especially when people are made more vulnerable by poor health. Official documents, including informed consent forms, social services forms, and public health and medical instructions, as well as health information materials often use jargon and technical language that make them unnecessarily difficult to use (Rudd et al., 2000).

When you have medical forms and stuff, I don’t think it should be complicated for a person to understand what its saying (Rudd and DeJong, 2000).

Some of the complexity of the health-care system arises from the nature of health care and public health itself, the mix of public and private financing, and the health information and health-care delivery settings. Unlike many other countries, the United States does not have a single organized national health-care system. Furthermore, the United States has no national health surveillance system, and few common norms exist for basic preventive services such as immunizations. Threats of bioterrorism and new emerging diseases such as SARS continue to complicate the picture of health care.

In the past, health management was primarily the domain of the physician, but greater responsibility for health management has shifted to the patient as health care has evolved and cost pressures on care have increased. This has been called self-management, and was identified in the Institute of Medicine (IOM) Priority Areas for National Action report (IOM, 2003b) as one of two cross-cutting issues in improving health-care quality that present the opportunity to improve health across the lifespan, at all stages of health service. In order to make appropriate self-management decisions, health information consumers must locate health information, evaluate the information for credibility and quality, and analyze the risks and benefits, activities that rely on health literacy skills. Consumers must be able to express health concerns clearly by describing symptoms in ways the providers can understand. Both patients and health-care providers must be able to ask pertinent questions and fully understand the available medical information.

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