title: The health care experience of patients with low literacy.
abstract: OBJECTIVE
  To understand the difficulties that patients with poor reading ability have interacting with the health care system and to identify the coping mechanisms they use to deal with these problems.
  
  
  METHODS
  Focus groups and individual interviews with patients who are illiterate and patients with low literacy.
  
  
  METHODS
  Two large, urban public hospitals.
  
  
  METHODS
  Sixty patients with marginal to poor reading abilities as measured by the Rapid Estimate of Adult Literacy in Medicine were interviewed in focus groups or individual interviews.
  
  
  RESULTS
  Patients with low literacy harbor a deep sense of shame, which is reinforced by hospital staff who become frustrated or angry when someone cannot complete a form or read instructions. Seeking medical care is intimidating for patients with low literacy because they cannot understand signs and registration forms. Many patients recounted serious medication errors resulting from their inability to read labels. To cope with these problems, the patients with low literacy rely heavily on oral explanations, visual clues, and demonstrations of tasks to learn new material. Most also use a friend or family member as a surrogate reader.
  
  
  CONCLUSIONS
  Patients with poor reading ability have important problems accessing the health care system, understanding recommended treatments, and following the instructions of providers. Because of their shame, patients with low literacy may be unwilling to disclose their problem to health care providers, and screening tests of reading ability may be necessary to identify those who need special assistance. Patients' coping mechanisms give insight into possible interventions that may improve their interactions with the health care system.
authors.affiliation: Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Baker
authors.forename: R M
authors.initials: RM
authors.lastname: Parker
authors.forename: M V
authors.initials: MV
authors.lastname: Williams
authors.forename: K
authors.initials: K
authors.lastname: Pitkin
authors.forename: N S
authors.initials: NS
authors.lastname: Parikh
authors.forename: W
authors.initials: W
authors.lastname: Coates
authors.forename: M
authors.initials: M
authors.lastname: Imara
mesh_terms: D000328:Adult; D002140:California; D004522:Educational Status; D017144:Focus Groups; D005845:Georgia; D006297:Health Services Accessibility; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D008508:Medication Errors; D010342:Patient Acceptance of Health Care; D011932:Reading; D012752:Shame