during clinical encounters. This report also recommended that a “patient-centered” approach be implemented to ensure that patients have full understanding of all of their options (IOM, 2001).

Access to Health Care and Preventive Services

Literacy and disparities are two sides common to a health phenomenon rather than two separate problems. Data continue to emerge to support the idea that the different needs of particular individuals and groups who have been historically marginalized or disenfranchised due to their ethnic or racial heritage, or social group identity or membership, continue to be unmet by the health-care system (IOM, 2003a). Inattention to patient preferences, lack of patient-centered care, and insufficient English proficiency (written or verbal) are contextual qualities that fuel health disparities among particular groups and individuals in the United States. In this way, limited health literacy may be a precursor to and condition of health disparities. Interventions to increase communications, improve access to health information, promote the understanding of meaning from facts, and transfer knowledge to actions are likely to reduce the negative impact of low literacy on patients’ access and use of health services.

Health services access involves many factors. These include financial ability to use services, lack of appropriate services located where people can reach them, times when services are available, health-care staff’s ability to appropriately navigate language and culture with patients, and respectful treatment of patients. Ethnic background and minority status also influence access to care (IOM, 2003a). Across all populations, the individuals most likely to be dissatisfied with seeking care are members of minority groups. These minority groups indicated they felt their race, ethnicity, and ability to pay for services directly affected their level of care (IOM, 2002b). An IOM report found differences in access and in treatment of patients who are poor, African American, Latino, and American Indian, among others (IOM, 2003a). Health literacy is an additional factor that should be considered when examining access to care and use of preventive services. Preliminary research supports such a link. This research is reviewed in Chapter 3. Briefly, individuals with limited health literacy as determined by the available measures are less likely to use preventive services such as mammograms and pap smears (Scott et al., 2002), and may come to the attention of the health-care system at a more advanced stage of disease (Bennett et al., 1998).

A lack of health insurance and lack of access to affordable services may lead people to postpone or not participate in care, particularly preventative care such as screenings, but also including recommended medical tests, treatments, and prescribed medications (Kaiser Commission on Medicaid



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