March 03, 2016
3 min read

Impact of health literacy under-recognized in management of patients with IBD

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Physicians should better understand the impact that limited health literacy can have on the clinical care of patients with inflammatory bowel disease, according to a recent review article, whose authors called for improved patient-provider communication and support for patient education and empowerment.

“A striking number of individuals, approximately one-third of adults in the United States, have limited health literacy,” Lauren K. Tormey, MD, from Boston Medical Center, told Healio Gastroenterology. “The impact of limited health literacy has been demonstrated in a variety of clinical contexts, and can be appreciated on both an individual and a health care system level.  Of particular concern is the link between limited health literacy and poorer health outcomes amongst individuals with chronic disease. We know that managing a chronic illness, such as inflammatory bowel disease, is complex for patients. With greater complexity, comes greater health literacy demands on individuals.”

Lauren K. Tormey

Tormey and colleagues sought to highlight how the clinical care of patients with IBD can be affected by limited health literacy, provide communication strategies for clinicians, and shed light on the need for further research and health literacy education programs for patients and providers.

Impact on outcomes, preventative care

Studies have demonstrated associations between limited health literacy and poor disease-specific knowledge, poorer health, increased mortality, increased risk for hospitalization and early readmission. Possible interventions to mediate the impact of limited health literacy on health outcomes may include improving health care access and utilization, as well as implementing support for patient self-care and patient-provider communication.

“To continually identify and understand factors that impact the health of patients living with IBD, further research in the IBD population is needed to examine these relationships,” the authors wrote.

Furthermore, it has been shown that individuals with limited health literacy “are more likely to avoid physician visits and have lower rates of screening and preventive health care service utilization.” In particular, poor health literacy has been linked to lower rates of vaccination among patients with IBD, and to lower rates of Pap smears and osteoporosis screening in other populations. “Given the increased incidence of abnormal Pap smears and greater risk of osteoporosis and osteopenia in some individuals with IBD, further studies are warranted,” they wrote.

Studies also show that limited health literacy can contribute to a number of barriers to screening and surveillance colonoscopy, and additional research is needed on the role of health literacy in cancer screening for patients with IBD specifically.

Patient education, empowerment

Despite evidence that limited health literacy may cause patients to avoid shared medical decision making, leading to “lower satisfaction and less patient-centered communication for patients with limited health literacy,” there continues to be a lack of resources for patient education programs.

“As the culture of medicine shifts toward shared decision making, we must develop an educational infrastructure that supports patient empowerment,” Tormey and colleagues wrote. “To address health literacy limitations, effective educational interventions will be those that go beyond the passive delivery of knowledge and seek to engage and empower patients by creating a personal context for self-care, encouraging critical thinking and promoting independence.”

Medical decision aids like the Crohn’s Disease Shared Decision Making Program may help patients to increase their knowledge and empower them to participate in decision making. Future research on these tools in populations with limited health literacy are needed.

Physician training

Studies show less than half of community internal medicine residency training programs provide formal health literacy education to residents, and like experienced clinicians, residents are overestimating the health literacy of a significant proportion of their patients.

There is an “unmet need for systems that reduce complexity, support providers and utilize educational tools in order to empower all patients, at all levels of health literacy, to engage in their care,” Tormey said.

It is therefore essential that health literacy concepts be incorporated into medical education programs “to help bridge the gap between patients and providers,” the authors wrote.

Moreover, their article includes “specific communication strategies for providers, guided by clear communication principles,” Tormey said. These principles encourage providers to present information simply and specifically, to use multiple forms of communication like pamphlets and pictures, to create an environment that encourages patients to ask questions, and to confirm patients comprehend the information. – by Adam Leitenberger

Disclosure: The researchers report no relevant financial disclosures.