Kathleen Hoffman, PhD

What is Health Literacy and Why Should Women Care?

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Health literacy is essential to care-giving in the 21st century. The term health literacy is confusing because we can be highly educated yet still have poor health literacy. So what is health literacy? It’s about understanding complex terminology. It’s about conversational competence like the ability to listen effectively, articulate health concerns and explain symptoms accurately. It’s also about evaluating, analyzing and deciding about one’s own care. It’s not just reading.

Health literacy is important for us as healthy women, but is it also critical for our family. As women, we are the caregivers in the family. According to a 2001 study, 80% of moms were responsible for choosing their children’s doctor, taking them to appointments and pursuing follow-up care. Moms were also responsible for making health insurance decisions and for caring for the extended family.

What happens when women are not health literate? We are less likely to receive preventative care, such as a mammogram or PAP smear. If we don’t seek important screening tests, we find diseases like breast or cervical cancer at later stages. Indeed, women with low health literacy are more likely to have chronic conditions like high blood pressure, diabetes and asthma and have difficulty managing these conditions.

Women with limited health literacy often lack knowledge or have misinformation about their body. Without this knowledge, we may not understand how and why diet and exercise are important in reducing the risk of certain illnesses and conditions. As the ones who take on much of the dietary responsibility of families, we need to know what is good for all of us and why.

If women are not health literate, we may also miss important information during critical health decision-making. In situations that are highly emotional, such as a diagnosis of cancer, it is difficult to recall and understand what has been said. Even under optimal circumstances, patients in these situations leave the physician’s office with only about 50% of the information that has been provided to them. If one is not health literate, the situation may be more dire. In one study, 80% of breast cancer patients with low health literacy made final decisions about their therapy after only one visit with an oncologist. When researchers compared these patients’ expectations about their chance of a cure to that of their oncologists, 60% of the women had overestimated their chance of a cure by 20% or more. While overestimating one’s chance for a cure might not be a bad thing, not getting a second opinion could be tragic.

A common complaint is that physicians do not explain illness and treatment options in easily understood terms. There is often a mismatch between a patient’s and physician’s expectations and understanding. Again, studies detail patients’ misunderstanding of common medical terms. When patients were tested for their understanding of words found in transcripts of physician-patient interviews a large variation in understanding occurred. While 98 percent of patients understood the health term vomit, only about one-third understood the word orally, 18% understood malignant and just 13 % the word terminal. In this same study, the physicians thought they were actually switching to everyday language when communicating with patients. Finally those with low health literacy are less likely to ask questions of their physician. This is tragic. The people who need more help actually receive less.

What can you do to become more health literate? Read and learn about your health condition. Talk to other women with similar conditions. Talk to your doctor, nurse and other healthcare professionals. While at the doctor’s office, you can try the simple technique called: Ask Me 3.
The program encourages patients to understand the answers to three questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?”

Taking these three questions with you during a doctor’s appointment, writing down the answers and making sure you understand everything that is said to you are ways to make a difference. If you think that the appointment will bring bad news, take a friend or family member with you. Don’t leave the physician’s office confused. You have the right to know what is happening to your body.


Dr. Kathleen Hoffman is an expert in health communications, and specifically in health literacy. Dr. Hoffman received her BS in pre-medicine from Davidson College, MS in public health from the University of North Carolina, Chapel Hill; MS in video production from Syracuse University and her PhD from the University of Alabama. She spent two years at Harvard, doing her fellowship in Health Communications. She has worked in academia, as a consultant for non-profits and in the corporate world. She’s blogging at Healthy Change Communications; http://healthychange4you.blogspot.com a blog that focuses on how patients and physicians communicate in the context of complex medical decision making.

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