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Low Health Literacy: Overview, Assessment, and Steps Toward Providing High-Quality Diabetes Care

 Although hypotheses about the link between literacy and health outcomes were published in the 1980s,1 the potential consequences of limited literacy in U.S. health care settings was brought to the attention of the larger clinical and health policy communities by a study published in 1995. In this landmark study, researchers revealed dramatic statistics: up to two-thirds of patients seen in public hospitals in the United States were unable to comprehend key health information such as how to take a medication or schedule a follow-up appointment.2 Hundreds of studies have since explored how patients' ability to read and comprehend the written information encountered in health care settings is independently associated with a variety of poorer health outcomes.

Because low literacy is more common among vulnerable populations (racial and ethnic minorities, elderly people, patients with chronic conditions, and those seeking care in public systems), it likely contributes to the disproportionate burden of disease-related problems among disadvantaged and vulnerable populations.3 In fact, when literacy is considered, the role of race in health disparities decreases dramatically.4,5
With an estimated 40% of adults in the United States having less-than-functional literacy,6 addressing health literacy has moved to the forefront of several policy agendas aimed at improving health care quality and outcomes.