Pharmacy research can help raise health literacy standards

Health literacy is defined by the Institute of Medicine as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."

As reported by the 2003 National Assessment of Adult Literacy, approximately 36% of adult Americans exhibit health literacy skills that are at the basic level or below. This affects people's ability to search for and use health information, adopt healthy behaviors, and act on important public health alerts. Limited health literacy affects people of all ages, races, incomes, and education levels; but the impact of limited health literacy disproportionately affects lower socioeconomic and minority groups, which includes racial and ethnic minorities as well as seniors. Limited health literacy is also associated with poorer health outcomes and higher costs.

With these concerns in mind, and guided by Michael J. Miller, RPh, DrPH, FAPhA, of the College of Pharmacy, The University of Oklahoma, Research in Social and Administrative Pharmacy solicited and compiled a collection of papers from top authorities from around the world, affiliated with prominent institutions such as the US Centers for Disease Control and Prevention and the US Department of Health and Human Services. Their collective contributions demonstrate pharmacy-relevant efforts supporting the US National Action Plan to Improve Health Literacy.

"The ideas generated from the research described in these papers should serve as a stimulus for future research and dialogue about a topic that is fundamental to ensuring optimal medication use, safety, and equity in health information-sharing," says Miller.

The US Department of Health and Human Services' 2010 National Action Plan to Improve Health Literacy defined seven goals to improve health literacy and suggested strategies for achieving them. The topics and studies in this special issue align most closely with goals on accessible, accurate, and actionable health information (Goal 1) and health-literate health care services (Goal 2). Improving quality and use of written communication materials, evaluating and creating environments that encourage active communication, and describing and testing novel ways to raise student awareness about health literacy issues highlight just a few of the important topics raised in this special themed issue.

Six studies examine the comprehensibility of patient education materials. Their conclusions support the value and necessity of clear communication and of designing and testing materials with the intended users.

Pharmacy schools are beginning to adopt health literacy as a framework for training the next generation of pharmacists to be effective communicators. Health literacy has begun appearing on syllabi, and has become a topic of experiential education activities. Six articles highlight the important role pharmacy schools are playing to further health literate pharmacy practice, while other contributions provide additional evidence of the important role pharmacy students can play in promoting health literacy in community pharmacies.

Other investigators found that to use the AHRQ Health Literacy Assessment to measure the impact of their training intervention, they had to modify the tool.

"The publication of this special issue on dissemination, translation, and evaluation of health literacy tools in pharmacy practice marks a significant accomplishment for the field," say editorial authors Cynthia Baur, PhD, of the Centers for Disease Control and Prevention, and Cindy Brach, MPP, of the Agency for Healthcare Research and Quality, US Department of Health and Human Services. "Health literacy education, training, and practice improvement tools can contribute to reorienting future and current pharmacists. But to create 'health literate pharmacies,' practitioners and researchers must collaborate in evidence-based redesign of the 'pharmacies of the future.' Our medication delivery systems must be designed to make clear communication easy rather than perpetuate confusion and errors. We can't rely on individual pharmacists' good will if the systems they operate in hamper their ability to promote the safe use of medicines."