Health Disparities: The Role of Health Communication

Modern medicine requires the active participation from patients to achieve the best results. To be informed consumers of health care, patients need to understand the health care choices they are making and be able to follow treatment plans developed by their doctors. The most recent data available suggest that only 12% adults scored proficient in health literacy, while 55% adults have intermediate health literacy and 22 % adults have basic health literacy. The remaining 12% adults had below basic literacy. Following familiar patterns in many other health outcomes, black and Hispanic Americans, people with less than high school degrees, and those who live in poverty are more likely to have basic or below basic health literacy. Older Americans and those with lower self-reported health are also more likely to have lower health literacy. Improving health literacy is one of the major goals of Healthy People 2020.

Health care providers can play a major role in improving health literacy of their patients. They could accomplish this by improving their communication skills and by offering specific help to patients related to health literacy. There have been few nationally representative studies on such effort by health care providers.  This paper uses the 2011-2013 waves of the Medical Expenditure Panel Survey to study three patient-reported measures of health care providers offering direct help to improve patient health literacy: always providing easy-to-understand instructions, always asking them to describe how to follow instructions, and offering help in filling out a form. We also look at four measures of patient- reported measures of their health care providers' communication skills: always listening carefully, always explaining things so that they could understand them, always showing respect for what they have to say, and always spending enough time with them. We study each of these measures in terms of how a patient's sex, age, race/ethnicity, education, income, health status, insurance status and location of the patient affect his/her interactions with health care providers.  For the subset who reported a usual source of care, we also look at how the gender, race/ethnicity, and specialty of health care providers influence their efforts communicating and helping patients with health literacy.  

Preliminary results suggest that although more than 60% of the MEPS respondents given any medical instructions said that they were always given easy to understand instructions, only a quarter reported their physicians asked them how they would follow instructions, and less than one in six reported any one in their doctor's office offered to help them fill out a form when required to do so. Further analyses suggest that the most vulnerable patients are not always given the help to improve their health literacy.