Americans overwhelmingly turned to the Centers for Disease Control and Prevention (CDC) last year for guidance on how to navigate their way through the COVID-19 pandemic. But many found they were unable to understand the complex vocabulary and instructions included in the CDC coronavirus safety measures.
The CDC broke its own guideline—one that both the American Medical Association (AMA) and the National Institutes of Health (NIH) try to maintain—to provide medical information in language that does not exceed the eighth-grade reading level (Mishra & Dexter, 2020).
The language the CDC used to inform the public was at an 11th-grade reading level— three levels higher than promised (Hirsch, 2020). This discrepancy led to a national conversation about the importance of health literacy, particularly how information should be written so the majority of people in the U.S. can understand it.
The Health Resources and Services Administration defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions” (Health Resources and Services Administration, 2019). The AMA has reported that around 89 million Americans, approximately 26 percent of the total U.S. population, do not possess this essential knowledge (Weiss, 2007).
The elderly, minority populations, low-income communities, and medically underserved persons are particularly vulnerable (Health Resources and Services Administration, 2019). Immigrants and citizens whose first language is not English also struggle (Weiss, 2007). Reports reveal that 42 percent of those with limited health literacy skills do not understand basic instructions like not taking medications on an empty stomach, and up to 78 percent of this group misinterpret warnings on their prescription labels (Weiss, 2007). More pressing given the current pandemic, this group is not fully aware of, nor can they understand, concepts of basic diseases (Weiss, 2007).
Low health literacy costs the U.S. health care system somewhere between $106 billion and $238 billion a year (National Library of Medicine). For fiscal and humanitarian reasons, proposals have been made to mend this issue.
Even before COVID-19, the AMA offered six suggestions for how medical professionals could improve their communication with patients.
- Slow down when speaking with patients. When done effectively, slower speaking increases a doctor’s time with a patient, will enrich the relationship between the two, and the care will become more patient-centered, leading to more understanding.
- Don't use clinical language. The patient will be able to take part in health care decisions if they are using the same terminology as their doctor.
- Use visuals to explain practices, as studies show images are more easily understood than spoken or written words (Weiss, 2007).
- Limit the amount of information given to a patient at one time. Information should be repeated to ensure the patient retains it and used as a bridge to provide more information.
- Use a teach-back technique. Ask patients to explain the information in their own words.
- Encourage patients to ask questions. Doctors can do their best to relay important information to a patient, but they need the patient to express what they are not understanding or voice any concerns they might have.
Confusion circulating public health information is not a uniquely American problem. Various international public health and government websites contain information presented at levels that exceed the American definition of the eighth-grade reading level. Even the World Health Organization has been found guilty of this. (Rodriguez, 2020).
As states encourage their populations to get COVID vaccines, they should adopt some of the AMA’s suggestions by replacing terms like variant and symptomatic/asymptomatic with words more people understand. Additionally, images that show potential side effects or infographics detailing the strengths of the vaccine type might be a powerful step forward toward ensuring better comprehension of this critical information during the pandemic.
Health Resources and Service Administration. (2019, August 13). Health literacy. Official website of the U.S. Health Resources and Services Administration. https://www.hrsa.gov/about/organization/bureaus/ohe/health-literacy/index.html#:~:text=Health%20literacy%20is%20the%20degree,to%20make%20appropriate%20health%20decisions
Hirsch, D. (2020, August 21). Federal and state websites flunk COVID-19 reading-level review. Dartmouth News. https://news.dartmouth.edu/news/2020/08/federal-and-state-websites-flunk-covid-19-reading-level-review
National Library of Medicine. (2011). Health literacy. Network of the National Library of Medicine. https://nnlm.gov/initiatives/topics/health-literacy#:~:text=According%20to%20the%20report%20Low,billion%20to%20%24238%20billion%20annually
Rodriguez, A. (2020, August 18). Many Americans may not comprehend COVID-19 information as agencies fail to meet health literacy guidelines, study says. USA Today. https://www.usatoday.com/story/news/health/2020/08/18/covid-cdc-white-house-fail-meet-health-literacy-guidelines/3389522001/
Mishra, V., & Dexter, J. P. (2020, August 18). Readability of public health information on COVID-19 from international agencies and governments. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769382
Weiss, B. D. (2007). Health literacy and patient safety: help patients understand (2nd ed.). AMA Foundation. http://www.partnershiphp.org/Providers/HealthServices/Documents/Health%20Education/CandLToolKit/2%20Manual%20for%20Clinicians.pdf