Oral Health Literacy: The New Imperative to Better Oral Health

Effective communication with patients is the cornerstone of quality dental care and oral health outcomes. Oral health literacy skills are critical to empowering individuals’ ability to improve their oral health. A large part of the American public has low health literacy skills. Low health literacy contributes to disease and is costly. Being able to understand health information and how to obtain services is critical to oral health management. The communication skills of the dental team are pivotal to increasing oral health literacy skills of Americans.

Have you ever experienced a misunderstanding with a patient about a given procedure or the outcome of a procedure? Has a patient ever called your office to clarify the self-care instructions after an appointment?

Effective communication with patients—speaking and presenting information in a clear and appropriate format and active listening—is essential to quality dental care and can contribute to successful oral health outcomes. Oral health outcomes are a product of numerous factors that contribute to oral health promotion and disease prevention. Factors, such as professional clinical dental care and appropriate self-care, play a key role, as do community initiatives like community water fluoridation and school dental sealant programs. To benefit from the many preventive measures that exist and to navigate through the health care system, patients need to be aware of the measures and the additional required services, know where to access them, and know how to use them appropriately. While patients obtain information from multiple sources, the clinical care and information provided to them by their dentist and dental team members serve to guide and inform their ability for optimum oral health self-care and decision-making related to health overall. The encounter with a dentist or dental hygienist is an opportunity for patients to receive guidance and learn skills for their self-care and for additional health services they may require. The communication skills of the dental team contribute to a patient’s health literacy that contributes to improved health outcomes.

What is health literacy?

There are several definitions for health literacy, each of which emphasizes the availability of skills to obtain, understand, and use health information appropriately, as shown in Table 1 . The World Health Organization was one of the first entities to define health literacy and lead the way to further modifications . Oral health literacy was first defined in Healthy People 2010, and is consistent with the definition for general health literacy: “The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions” . Inherent in all definitions is the concept that health outcomes would improve by facilitating people’s access to health information and their capacity to use it effectively. In this manner health literacy skills are critical to empowering people’s ability to promote and improve their health.

Table 1
Health literacy definitions compared
Definition Keywords
WHO “Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use the information in ways which promote and maintain good health.” World Health Organization skills→ motivation and ability→ access, understand, use→ promote and maintain health
United States “The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” Ratzan & Parker , Healthy People 2010 Degree of capacity→ obtain, process, understand, basic information, services→ appropriate health decisions
Oral Health Literacy “The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions.” Healthy People 2010 Degree of capacity→ obtain, process, understand, basic information, services→ appropriate health decisions

Health literacy was given wide visibility with the simultaneous release of the Institute of Medicine’s (IOM) report, Health Literacy: A Prescription to End Confusion and the Agency for Health care Research and Quality’s Literacy and Health Outcomes . Earlier reports highlighted aspects of the challenge facing our nation: 50% of United States adults do not read well enough to decipher a bus schedule . Another IOM report, Communicating Health: Priorities and Strategies for Progress , emphasized that everyone has a right to science-based health information that is provided in ways that can be understood . In the dental setting, the use of dental terms, such as periodontal disease, dental caries, and orthodontia can act as barriers to the understanding of most patients. The words and media we use to describe emerging science-based findings and patient information, and our health education and other print material, are our tools for effective communication. This includes diverse materials, such as newsletters, informed consent forms, insurance forms, health histories, and instructions for home care after dental procedures.

Health literacy is more than the ability to read and encompasses a number of other skills. These skills include writing, listening, numeracy or the ability to use math, and oral communication . In addition, health literacy entails the ability to navigate our challenging health system and is affected by education, culture, and the context of the situation. To highlight the complexity of factors affecting health literacy, the schematic from the IOM report is shown in Fig. 1 . The interactions and roles of the health care system emphasize the importance of health care providers and policy makers . All health care providers are either overtly or inadvertently intimately involved in health literacy. The focus on health literacy comes at a time when our country’s demographics are rapidly changing and the requirements of self-care and health services are increasing.

Fig. 1
Oral health literacy framework. ( Adapted from Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004. p. 5; with permission.)

Why is health literacy important?

The simple answer to the question of why health literacy is important is that poor or low health literacy contributes to disease, and this costs the nation and individuals a lot of money. In a recent study, it was estimated that the cost of low health literacy ranges between $106 billion to $238 billion annually . This represents between 7% to 17% of all personal health care expenditures. Individuals with low health literacy have increased use of emergency care, poor control of diabetes, and are less likely to use preventive regimens and screenings than individuals with high health literacy . In addition, health literacy is now recognized as an important determinant of health. Health literacy skills vary across different health topics, including diabetes, cancer, heart disease, and oral health. Health literacy is now recognized as an important determinant of health. Being able to understand health information and how to obtain services is critical to all aspects of personal health management .

Those at highest risk for low levels of health literacy include individuals 65 years of age and older, those who have less than a high school education, and those belonging to racial or ethnic minority groups . According to the first national survey on health literacy, a component of the 2003 National Assessment of Adult Literacy (NAAL), Hispanic adults had lower average health literacy than adults in any other group . The continuing demographic increases in racial and ethnic minorities and persons 65 years of age and older will continue to challenge our population’s health literacy.

The 2003 NAAL survey also revealed that 44% of Americans responded in the intermediate level of prose literacy. Intermediate level means they can make only simple inferences and apply information from moderately dense text. For example, only one in ten United States adults is proficient in understanding health related written materials. At the other end of the phase, one in three Americans fall within either the basic level (22%) literacy or below the basic level (14%), which means they have difficulty understanding and applying health information. These survey findings highlight the mismatch between the capability of a large proportion of the United States public and the demands of the health care system . Most health care information, including insurance forms, informed consent forms, patient health instruction or education materials, and hospital or clinic signs are often complex and written at reading levels far exceeding the abilities of the majority of American adults .

The demands of health care providers and the health care system are complex and can challenge even those who are well educated. At any given time, anyone—regardless of level of education, age, race, and ethnic characteristics—may be challenged in their interface with the United States health care system. The problem of limited health literacy is perhaps best described as a functional mismatch between the skills of the individual and the demands placed on that individual by the health care system and its providers . The transmission and receipt of information depends on the capacity of both the sender and the receiver, and this capacity is affected by the setting (a dental patient being in a prone position), context (a procedure that is preventive versus one that is surgical), and format of the information delivered, among other factors.

Provider interpersonal and communication skills, and the ability of patients to understand and use the information are critical to the process. Most of us assume that our oral instructions and information are listened to, are clear, and are understood. However this assumption is not always valid, especially in health care settings where many are ill at ease and even fearful. It can be difficult to hear and understand what is being said during stressful times, and even more difficult to compose and ask relevant questions. Formal training in communication would allow us to assess the abilities of our individual patients, work with our team members to present effective and tailored oral, written, and other forms of health information.

Why is health literacy important?

The simple answer to the question of why health literacy is important is that poor or low health literacy contributes to disease, and this costs the nation and individuals a lot of money. In a recent study, it was estimated that the cost of low health literacy ranges between $106 billion to $238 billion annually . This represents between 7% to 17% of all personal health care expenditures. Individuals with low health literacy have increased use of emergency care, poor control of diabetes, and are less likely to use preventive regimens and screenings than individuals with high health literacy . In addition, health literacy is now recognized as an important determinant of health. Health literacy skills vary across different health topics, including diabetes, cancer, heart disease, and oral health. Health literacy is now recognized as an important determinant of health. Being able to understand health information and how to obtain services is critical to all aspects of personal health management .

Those at highest risk for low levels of health literacy include individuals 65 years of age and older, those who have less than a high school education, and those belonging to racial or ethnic minority groups . According to the first national survey on health literacy, a component of the 2003 National Assessment of Adult Literacy (NAAL), Hispanic adults had lower average health literacy than adults in any other group . The continuing demographic increases in racial and ethnic minorities and persons 65 years of age and older will continue to challenge our population’s health literacy.

The 2003 NAAL survey also revealed that 44% of Americans responded in the intermediate level of prose literacy. Intermediate level means they can make only simple inferences and apply information from moderately dense text. For example, only one in ten United States adults is proficient in understanding health related written materials. At the other end of the phase, one in three Americans fall within either the basic level (22%) literacy or below the basic level (14%), which means they have difficulty understanding and applying health information. These survey findings highlight the mismatch between the capability of a large proportion of the United States public and the demands of the health care system . Most health care information, including insurance forms, informed consent forms, patient health instruction or education materials, and hospital or clinic signs are often complex and written at reading levels far exceeding the abilities of the majority of American adults .

The demands of health care providers and the health care system are complex and can challenge even those who are well educated. At any given time, anyone—regardless of level of education, age, race, and ethnic characteristics—may be challenged in their interface with the United States health care system. The problem of limited health literacy is perhaps best described as a functional mismatch between the skills of the individual and the demands placed on that individual by the health care system and its providers . The transmission and receipt of information depends on the capacity of both the sender and the receiver, and this capacity is affected by the setting (a dental patient being in a prone position), context (a procedure that is preventive versus one that is surgical), and format of the information delivered, among other factors.

Provider interpersonal and communication skills, and the ability of patients to understand and use the information are critical to the process. Most of us assume that our oral instructions and information are listened to, are clear, and are understood. However this assumption is not always valid, especially in health care settings where many are ill at ease and even fearful. It can be difficult to hear and understand what is being said during stressful times, and even more difficult to compose and ask relevant questions. Formal training in communication would allow us to assess the abilities of our individual patients, work with our team members to present effective and tailored oral, written, and other forms of health information.

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Oct 29, 2016 | Posted by in General Dentistry | Comments Off on Oral Health Literacy: The New Imperative to Better Oral Health
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