ACCESSING HEALTH EQUITY
Informed care
The barriers to health literacy By Jess Kirby
I
n recent years, physicians have begun to understand and appreciate the crucial link between health literacy and positive
patient outcomes. In order to self- report symptoms, manage chronic health concerns, adhere to aftercare instructions or provide informed consent, understanding is key to the patient–physician relationship. But due to barriers such as language differences, limited resources, and varied consent and education processes, patients are not always adequately informed when managing their health and consenting to procedures.
Health literacy According to the National Academy of Medicine, health literacy is an individual’s capacity to obtain, process and understand basic health
information and services needed to make appropriate health decisions.1 Multiple studies show that health literacy is low among demographics such as low-income elderly, racial and ethnic minorities, and individuals from lower- income socioeconomic groups—the same groups who experience the largest disparities in terms of health outcomes, unconscious bias and access to care.2,5
The Institute of Medicine3 has proposed
a model of health literacy comprised of four pillars: cultural and conceptual knowledge, print health literacy (reading and writing), oral health literacy (listening and speaking) and numeracy.
“Health literacy is fundamental to a person’s ability to make the best healthcare decision for themselves or for their families,” said Isabel Newton, MD, PhD, co-founder and chair of The
Interventional Initiative, a nonprofit which seeks to educate on minimally invasive, image-guided procedures. “Healthcare decisions are personal and depend on one’s health issues, values, goals of care, barriers to access to care and opportunities to overcome them.”
When it comes to surgeries and procedures, the ethical onus falls on the clinician to ensure that the patient has the necessary understanding in order to consent to treatment, though it can be difficult to make sure that all four pillars are accounted for.4
"I'm passionate that patients should be able to make informed choices about their care,” said Eric Keller, MD, founder of the Applied Ethics in IR Initiative and board member of The Interventional Initiative. “Unfortunately, data suggest that many patients do not receive the information they need prior to healthcare decisions.”
Barriers to literacy Ideally, informed consent would be conducted in a comfortable and noncoercive setting and in the patient’s native language, said Helena Rockwell,
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