To the Editor: Literacy is indeed a factor in health care, and I was pleased to read the commentary by Drs. Grace and Christensen (1) on literacy and mental health care in the January 1998 issue. While I agree that it is important for all clinicians to recognize illiteracy, I take issue with the suggestions for change.
The commentary recommends that clinicians "routinely evaluate their patients' literacy skills" and suggests the use of the Rapid Estimate of Adult Literacy in Medicine (REALM). I agree that clinicians must be aware that literacy is a problem for some patients, but I suggest that action be taken on an organizational, rather than an individual, basis.
Studies have shown that nearly half of the U.S. population has difficulty reading complex written material (2). Therefore, why not have all materials written in ways that are clear and simple? If the REALM is used to test each individual, what happens next? Will all written materials be available at appropriate reading levels? And what about the individual who now has revealed an inability to read? Is there adequate access to literacy programs?
The authors write that "once literacy problems are identified, patients can receive information appropriate to their reading level." I suggest alternative teaching tools be made available in addition to accessible written information. Such tools may include pictures, demonstration models, and videotapes and audiotapes. Technology, too, is providing alternative teaching methods such as the use of interactive touch screens.
In working to create solutions to literacy problems in health care, I have used both clinical and administrative approaches. I have taught clinicians the skills of clear and simple communication, both written and verbal, and have established systems to maintain these gains. A series of articles about this work was published in the February 1998 issue of the newsletter Patient Education Management.
It is important to communicate in ways people can understand. I support Psychiatric Services' efforts to raise awareness about literacy as a factor in health care.
Ms. Osborne is director of health education at Carney Hospital in Boston and a consultant on health literacy.