Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health care decisions (IOM, 2004).
Low health literacy is a significant problem in the United States, with more than 36 percent of the adult population (approximately 80 million people) having poor health literacy (AHRQ, 2011). While a lack of health literacy is more likely to be an issue with more vulnerable populations, the problem affects all social and demographic groups. Some of the difficulties experienced by individuals with limited health literacy include problems in communicating with clinicians, greater barriers in managing chronic illness, less likelihood of receiving preventive care, a greater likelihood of experiencing serious medication errors, increased risk of hospitalization, and poorer quality of life (AHRQ, 2011).
The Institute of Medicine (IOM) Roundtable on Health Literacy focuses on bringing together leaders from the federal government, foundations, health plans, associations, and private companies to address challenges facing health literacy practice and research and to identify approaches to promote health literacy in both the public and private sectors. The roundtable serves to educate the public, press, and policy makers regarding the issues of health literacy, sponsoring workshops to
1 This workshop was organized by an independent planning committee whose role was limited to identification of topics and speakers. This workshop summary was prepared by the rapporteur as a factual summary of the presentations and discussions that took place at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Roundtable or the National Academies, and they should not be construed as reflecting any group consensus.
discuss approaches to resolve health literacy challenges. It also builds partnerships to move the field of health literacy forward by translating research findings into practical strategies for implementation.
Most health literacy research has focused on patient skills and abilities and on interventions designed to improve those skills and abilities. However, there is growing recognition that health literacy depends not only on individual skills and abilities but also on the demands and complexities of the health care system. It is of primary importance therefore, to develop strategies that health care organizations can use to improve their health literacy–promoting attributes. Yet organizations often find it difficult to determine exactly what it means to be health literate.
The roundtable decided to commission a paper that would present and explore a set of attributes that define a health literate health care organization. A health literate health care organization is defined as “an organization that makes it easier for people to navigate, understand, and use information and services to take care of their health” (Brach et al., 2012). Developing such a paper was a tremendous challenge, and the roundtable is very appreciative that Dr. Dean Schillinger, with the assistance of Dr. Debra Keller, consented to write the paper. The focus of the workshop was to unveil the paper and to receive feedback and input on the ideas presented. Based on the feedback from the workshop as well as from other sources, the paper on attributes will be revised.
The workshop was organized by an independent planning committee in accordance with the procedures of the National Academy of Sciences. The planning group was composed of Cynthia Baur, Cindy Brach, Benard Dreyer, Jean Krause, Ruth Parker, and Paul Schyve. The workshop featured the presentation of a commissioned paper on the attributes of a health literate organization and invited presentations and discussions in reaction to the paper as well as discussion of other topics related to health literacy. The workshop was moderated by roundtable chair, George Isham, and featured presentations and discussions. Chapter 2 is the presentation of the commissioned paper. Chapters 3, 4, and 5 describe the reactions of providers from different health care settings, including a health care executive working in a public hospital system, the director of a public clinic, a physician in private practice, a pharmacist in a pharmacy chain, a dentist in private practice, and a nurse from a visiting nurses association. This workshop summary report is not meant to imply that the presenters’ views can be generalized as representative of the opinions of all providers in a particular type of health care setting. Rather, the report is a summary of the presentations made. Each of these individuals was asked to address the following questions:
1. Which attributes would be your top priorities?
2. Is your organization likely to undertake activities to implement these attributes?
3. What are the challenges to implementing those attributes?
4. Which attributes do you feel you are already making progress on?
5. What incentives would make your organization more likely to take on this work?
6. Are there any attributes you think are infeasible or undesirable? Why?
Chapter 6 summarizes the presentations of the final workshop panel, which consisted of speakers from organizations that can or do provide incentives for other organizations to engage in specific activities such as implementing health literacy approaches. These presenters were asked to address the following questions:
1. Which attributes do you think are most important? Why?
2. Are there any attributes you think unfeasible or undesirable? Which ones and why?
3. What do you think are the challenges for implementing these attributes?
4. How could your organization encourage the implementation of these attributes?
Chapter 7, the final chapter, includes a general discussion of the workshop’s presentations.
AHRQ (Agency for Healthcare Research and Quality). 2011. Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence Report/Technology Assessment, No. 199. http://www.ahrq.gov/clinic/epcsums/litupsum.htm (accessed December 10, 2011).
Brach C., B. Deyer, P. Schyve, L. M. Hernandez, C. Bauer, A. J. Lemerise, and R. Parker. 2012. Attributes of a Health Literate Organization. Discussion Paper, Institute of Medicine, Washington, DC. www.iom.edu/healthlit10attributes (accessed April 4, 2012).
IOM (Institute of Medicine). 2004. Health literacy: A prescription to end confusion. Washington, DC: The National Academies Press.
