Low health literacy is far more prevalent than commonly believed in the United States. Many researchers have found that it is a common experience for clients not to understand the health care information given to them. One study found that clients were able to recall 50% or less of the information given to them immediately after leaving the physician’s office.⁴ Reviewing over 100 studies, Rudd, Moeykens, and Colton⁴ discovered that many clients did not understand health information they received from a health care provider. In 2003, the U.S. Department of Education⁵ conducted a study to assess the literacy and health literacy of adults, ages 16 and over, in the United States. Health literacy results were reported using four literacy levels:

The results were surprising. According to this study, 14% of the study population had below basic health literacy; 22% had basic health literacy; 53% had intermediate literacy; and 12% had proficient health literacy. These statistics indicate that almost 90 million American adults lack the ability to understand basic health information sufficient to make appropriate health decisions.⁵

Alarmingly, the demographics of this study reveal that it is the most vulnerable Americans who are more likely to have this deficiency. The groups that are overrepresented in low health literacy are older adults, minorities, the uneducated, and the poor. Table 14-1 provides representative statistics for these various groups.

People age 65 and over had the lowest average health literacy scores compared to adults in any other age category. The more educated one was, the less likely they were to have low health literacy. Income level was positively correlated with health literacy and, as household income increased, health literacy scores also increased. Minorities were also found to have higher rates of low health literacy, and individuals for whom English is their second language are at increased risk as well.5 In the following example, low health literacy led to ineffective symptom relief:

Low health literacy is associated with high rates of hospitalization, less frequent use of preventive services, as well
as increased morbidity and mortality.² The costs associated with poor health literacy in terms of health care dollars are both quantifiable and staggering. Weiss³ estimates the cost of poor health literacy in the United States to be 50 to 73 billion dollars per year. Poor health literacy contributes significantly to the health care crisis that exists in the United States and is such an important issue that it is frequently cited as one of the national objectives for achieving a greater state of health.¹,⁵

Low health literacy is also costly in terms of human lives and suffering. Generally, there is a reduced compliance with medication and medical regimens. When clients fail to understand the information given to them, they do not follow instructions, do not take medications the right way, and do not perform self-care as instructed.