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Currents |16 February 1999

Illiteracy: The Silent Barrier to Health Care

Paul T. Kefalides, MD

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Workers in the field of health communication are sounding a warning on patients' reading skills. Emerging literature on illiteracy and health care indicates that up to 50% of certain clinical populations may be unable to read and understand medical instructions. As health care moves from the hospital to the home, researchers and clinicians are becoming increasingly aware of the challenges presented by the large number of illiterate patients. Mistakes resulting from poor reading skills can lead to repeated hospitalizations and may be costing the health care industry billions of dollars. In response, a group of public health researchers propose that physicians use pictographs when instructing patients; others suggest devoting extra attention to some patients with substandard reading skills and multiple medical problems.
Longstanding concerns for the high rate of illiteracy in the United States were highlighted by the National Adult Literacy Survey (NALS), which examined the reading skills of 26 000 adults in 1992. When extrapolated to the whole population, the NALS data suggest that about 40 million Americans cannot read or write and another 45 million have only marginal reading skills. These marginally literate persons can sound out a sentence but may not understand its meaning or be able to respond to written instructions. Of the survey respondents with the poorest skills, two thirds were 65 years of age or older and one quarter were immigrants learning English as a second language. The majority of illiterate persons were white and born in the United States. More than 20% of...
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Kefalides PT. Illiteracy: The Silent Barrier to Health Care. Ann Intern Med. 1999;130:333–336. doi: 10.7326/0003-4819-130-4-199902161-00001

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Published: Ann Intern Med. 1999;130(4_Part_1):333-336.

DOI: 10.7326/0003-4819-130-4-199902161-00001

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