Health Literacy, COVID, and the SDoH  

Over the course of the continuing COVID-19 pandemic, one topic has mysteriously fallen under the radar. It’s something that greatly impacts health outcomes, and especially virus transmission rates. The Joint Commission identified this issue in 2008 as among the most important factors to impact population health.

Any ideas? One final hint: the topic was highlighted in the latest version of Health People 2030, as a critical social determinant to further drive health disparities. For those whose brains are moving a tad slower today, I’m referring to health literacy.

As opposed to language literacy, which is about how well you speak and understand a language, health literacy is the degree to which individuals obtain, process, and understand basic health information needed to make appropriate health decisions. Low health literacy is more prevalent among:

• Older adults
• Minority populations
• Those who have low socioeconomic status
• Medically underserved people

We’re talking about over 50 percent of U.S. adults: more than 100 million Americans who can’t understand all the information being conveyed about their healthcare.

In the context of COVID, low health literacy impacts understanding of public health precautions: the why, what, where, when, and how of virus transmission. Health literacy involves knowing what to make of a diagnosis and how severe it is. It impacts understanding informed consent, weighing the pros and cons of healthcare decisions about treatment, procedures, follow-up care appointments, discharge planning options, and medication instructions. Let’s really hone in on those factors to mitigate increased hospital utilization and prompt readmissions, and increased length of stay and costs.

In the scope of COVID and transmission, challenges abound for patients with poor health literacy unable to fully understand what they read or are told about the virus. Research on more than 5,100 adults released by the Kennedy School at Harvard revealed that:

• Black people, males, and individuals younger than 55 were less likely to know how COVID spreads and its key symptoms.
• Black patients were 9 percent less likely than whites to know how the virus can spread.
• Black men were 5 percent less likely to know this information than black females.
• These populations were less likely to engage in key healthy behaviors that reduce COVID transmission, especially regular handwashing and social distancing, as well as the need for masks.

Research out of the University of Alabama at Birmingham Hospital noted:

• Patients with low health literacy levels are 4.5 times more likely to experience a post-surgical infection than individuals with adequate health literacy levels.
• Low health literacy is linked to a longer hospitalization and an increased rate of minor complications.

Of the 270 patients studied:
 

• 9 percent had adequate health literacy, 14.1 percent marginal health literacy, and 7 percent low health literacy
• 8 percent with low health literacy had a post-op infection

Countless tools support health literacy:

• The Joint Commission has an online health equity portal with free resources.
• The Centers for Disease Control and Prevention (CDC) released Health Literacy Guidance & Tools, an online educational module for public health professionals on health literacy and effective communication techniques.

• The AHRQ Health Literacy Universal Precautions Toolkit provides tools to improve spoken and written communication and self-management.
• The U.S. Department of Health and Human Services (HHS) has a Health Literacy Online Guide  that addresses development of health websites and digital tools for online health information.

Health literacy is an easy fix for organizations, but the easiest tasks are often those that evade attention the most. Our Monitor Mondays Listener Survey asked our audience how big an issue health literacy is for their organizations. The answers were surprising, and accessible here.

Programming Note: Ellen Fink-Samnick, a member of the RACmonitor editorial board, is a permanent panelist on Monitor Mondays. Listen to her live reporting on SDoH every Monday at 10 a.m. EST.