Leaders in Patient Education: Health Literacy Knowledge and Experience Unlocks the Door to Effective Patient Education

Nurses take the lead in patient education over all other healthcare professionals yet a review of the literature indicates nurses have little knowledge about the effect of health literacy on patient education.  The purpose of this review was to examine nurses’ knowledge and experience with health literacy.   Health literacy is the ability to understand health information and maneuver within the health system and is critical to patient outcomes.  Approximately 88% of the adult population has limited health literacy (HHS, 2010) and this problem results in an estimated $238 billion dollars in healthcare costs (Vernon, Trujillo, Rosenbaum & DeBuono, 2007).  The enormity of the problems related to limited health literacy makes the connection to nursing of utmost importance.  A systematic search for evidence regarding nurses’ knowledge of health literacy as well as their experience with health literacy revealed few studies demonstrating the connection.  Nurses appear to be unaware of risk factors, assessment tools and best teaching methods for those with limited health literacy. Jukkala, Deupree and Graham (2009) as well as Schwartzberg, Cowett, Van Geest and Wolf (2007) examined health literacy knowledge among several healthcare professionals including nursing.  Cormier and Kotrlik’s (2007) survey measured baccalaureate nursing student’s health literacy knowledge and experience. Torres (2014) used the same tool to look at associate degree nursing student’s health literacy knowledge.  The tool was used once again by Knight (2011) to measure Registered Nurses knowledge and experience of health literacy in Georgia. Cafiero (2013) measured health literacy knowledge and experience as well as intention to use health literacy strategies in a population of nurse practitioners.  Sand-Jecklin, Murray, Summers and Watson (2010) and McCleary-Jones (2012) conducted pre and post tests of health literacy knowledge in nursing students to assess the benefits of a health literacy education session.  Scheckel, Emery and Nosek (2010) used interpretive phenomenology to examine a purposive sample of nursing students’ health literacy experiences.  Although the participants in several studies were nursing students, the results are indicative of their health literacy knowledge and experience at the beginning of their nursing careers.  The results revealed knowledge gaps in many areas of health literacy such as identifying high risk groups of low health literacy, use of screening tools and assessment of written patient literature. Several studies focusing on nursing students’ found their health literacy knowledge to have some gaps but was adequate overall (Cormier & Kotrlik, 2009; Cafiero, 2013; Knight, 2011; McCleary-Jones, 2012; Sand-Jecklin, Murray, Summers & Watson, 2010; Scheckel, Emery & Nosek, 2010;  & Torres and Nichols, 2014).  However,  results from health literacy studies looking at large groups of healthcare professionals revealed nurses were the group with the least knowledge in health literacy (Jukkala, Deupree and Graham, 2009; Schwartzberg, Cowett, VanGeest & Wolf, 2007).  It is recommended that nurses take the lead in becoming knowledgeable about health literacy. Nursing school curricula should be examined to include the needed background of health literacy for the education of nursing students.  Future research should focus on specific areas of nursing where knowledge and experience in health literacy is especially important but may be lacking. There is also an apparent need to provide nurses with knowledge about health literacy assessment tools and modified patient teaching methods to prepare nurses for their role as leaders in patient education.