Becoming Literate in Health Literacy

Becoming Literate in Health Literacy Association of Health Literacy With Outcomes in Patients Undergoing Abdominal Surgery Original Investigation Research Invited Commentary Richard Carmona, MD, MPH; Andrew Pleasant, PhD First, we would like to commend the authors for taking on this care 4 to 7 years ago. Why was there a gap or delay in publish- complex issue of the relationship between health literacy and ing these results? surgical outcomes. As a fellow surgeon and professor, I (R.C.) The Brief Health Literacy Screen that was used as a mea- know that surgeons are rarely singled out for exceptional com- sure of health literacy in this study is simple but of limited munication skills. I am happy that my colleagues are entering value. However, to our knowledge, there is currently not a the field of health literacy. widely accepted, valid, and reliable standard of health lit- eracy measurement. We are both aware that clear, succinct, understandable, and health-literate preoperative and postoperative instruc- The study sample was predominately English-speaking and tions can be a significant determinant of the outcomes white, relatively well-educated, and undergoing elective sur- and the cost of care. Health gery. This is not a representative sample. One would expect literacy affects every person, a more diverse sample, and including emergency surgery as a Related article page 137 health professional, and characteristic would show lower health literacy levels and more type of prevention or care. postsurgical complications as a result. Yet, health literacy remains an afterthought or academic dis- This report focuses on the deficit of health literacy defi- cussion rather than a common and essential daily practice cit among people. However, that is only half of the issue. 2-4 that is integrated into every encounter. Often, health care professionals are not taking the needed While one of us (R.C.) served as Surgeon General of the time or providing clear, concise, understandable, and usable United States, publishing reports and providing hundreds of information. Overall, we argue that the field of health lit- presentations annually, it became evident that translating com- eracy needs to increase efforts to develop sustainable, mea- plex science in a health-literate and culturally competent man- surable, and effective interventions vs expending more ner was the only way to effectively reach people. Only by ad- energy on proving that health literacy is a problem that dressing and embracing health literacy can the United States everyone faces. and the world help people make sustainable and informed All health professionals must aggressively embrace health changes in their behavior to improve quality and quantity of literacy and cultural competence. Otherwise, the gap be- life at a decreased cost. tween current realities and the goals of health system optimi- Although we admire the efforts of our colleagues, we would zation, decreased clinician variability, preventing disease, low- like to provide some constructive comments. First, the data ering surgical complications, and reducing the economic that were used in this study were from a cohort that received burden of health and health care will continue to widen. ARTICLE INFORMATION REFERENCES: 4. Pleasant A, Kuruvilla S. A tale of two health literacies: public health and clinical approaches to Author Affiliations: University of Arizona, Tucson 1. Wright JP, Edwards GC, Goggins K, et al. health literacy. Health Promot Int. 2008;23(2): (Carmona); Health Literacy Media, St Louis, Association of health literacy with postoperative 152-159. Missouri (Pleasant). outcomes in patients undergoing major abdominal surgery [published online October 4, 2017]. JAMA 5. Pleasant A. Health literacy: an opportunity to Corresponding Author: Richard Carmona, MD, Surg. doi:10.1001/jamasurg.2017.3832 improve individual, community, and global health MPH, 17th Surgeon General of the United States, [published online June 15, 2011]. New Dir Adult University of Arizona, 8600 E Rockcliff Rd, Tucson, 2. Zarcadoolas C, Pleasant A, Greer D. Advancing Contin Educ. 2011;2011:43-53. doi:10.1002/ace.409 AZ 85750 (rcarmona@canyonranch.com). Health Literacy: A Framework for Understanding and Action. San Francisco, CA: Jossey Bass; 2006. 6. Pleasant A, McKinney J, Rikard RV. Health Published Online: October 4, 2017. literacy measurement: a proposed research agenda. doi:10.1001/jamasurg.2017.3835 3. Pleasant A. Advancing health literacy J Health Commun. 2011;16(suppl 3):11-21. measurement: a pathway to better health and Conflict of Interest Disclosures: None reported. health system performance. J Health Commun. 2014;19(12):1481-1496. doi:10.1080/10810730.2014 jamasurgery.com (Reprinted) JAMA Surgery February 2018 Volume 153, Number 2 143 © 2017 American Medical Association. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

Becoming Literate in Health Literacy

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American Medical Association
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Copyright 2017 American Medical Association. All Rights Reserved.
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2168-6254
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2168-6262
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10.1001/jamasurg.2017.3835
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Abstract

Association of Health Literacy With Outcomes in Patients Undergoing Abdominal Surgery Original Investigation Research Invited Commentary Richard Carmona, MD, MPH; Andrew Pleasant, PhD First, we would like to commend the authors for taking on this care 4 to 7 years ago. Why was there a gap or delay in publish- complex issue of the relationship between health literacy and ing these results? surgical outcomes. As a fellow surgeon and professor, I (R.C.) The Brief Health Literacy Screen that was used as a mea- know that surgeons are rarely singled out for exceptional com- sure of health literacy in this study is simple but of limited munication skills. I am happy that my colleagues are entering value. However, to our knowledge, there is currently not a the field of health literacy. widely accepted, valid, and reliable standard of health lit- eracy measurement. We are both aware that clear, succinct, understandable, and health-literate preoperative and postoperative instruc- The study sample was predominately English-speaking and tions can be a significant determinant of the outcomes white, relatively well-educated, and undergoing elective sur- and the cost of care. Health gery. This is not a representative sample. One would expect literacy affects every person, a more diverse sample, and including emergency surgery as a Related article page 137 health professional, and characteristic would show lower health literacy levels and more type of prevention or care. postsurgical complications as a result. Yet, health literacy remains an afterthought or academic dis- This report focuses on the deficit of health literacy defi- cussion rather than a common and essential daily practice cit among people. However, that is only half of the issue. 2-4 that is integrated into every encounter. Often, health care professionals are not taking the needed While one of us (R.C.) served as Surgeon General of the time or providing clear, concise, understandable, and usable United States, publishing reports and providing hundreds of information. Overall, we argue that the field of health lit- presentations annually, it became evident that translating com- eracy needs to increase efforts to develop sustainable, mea- plex science in a health-literate and culturally competent man- surable, and effective interventions vs expending more ner was the only way to effectively reach people. Only by ad- energy on proving that health literacy is a problem that dressing and embracing health literacy can the United States everyone faces. and the world help people make sustainable and informed All health professionals must aggressively embrace health changes in their behavior to improve quality and quantity of literacy and cultural competence. Otherwise, the gap be- life at a decreased cost. tween current realities and the goals of health system optimi- Although we admire the efforts of our colleagues, we would zation, decreased clinician variability, preventing disease, low- like to provide some constructive comments. First, the data ering surgical complications, and reducing the economic that were used in this study were from a cohort that received burden of health and health care will continue to widen. ARTICLE INFORMATION REFERENCES: 4. Pleasant A, Kuruvilla S. A tale of two health literacies: public health and clinical approaches to Author Affiliations: University of Arizona, Tucson 1. Wright JP, Edwards GC, Goggins K, et al. health literacy. Health Promot Int. 2008;23(2): (Carmona); Health Literacy Media, St Louis, Association of health literacy with postoperative 152-159. Missouri (Pleasant). outcomes in patients undergoing major abdominal surgery [published online October 4, 2017]. JAMA 5. Pleasant A. Health literacy: an opportunity to Corresponding Author: Richard Carmona, MD, Surg. doi:10.1001/jamasurg.2017.3832 improve individual, community, and global health MPH, 17th Surgeon General of the United States, [published online June 15, 2011]. New Dir Adult University of Arizona, 8600 E Rockcliff Rd, Tucson, 2. Zarcadoolas C, Pleasant A, Greer D. Advancing Contin Educ. 2011;2011:43-53. doi:10.1002/ace.409 AZ 85750 (rcarmona@canyonranch.com). Health Literacy: A Framework for Understanding and Action. San Francisco, CA: Jossey Bass; 2006. 6. Pleasant A, McKinney J, Rikard RV. Health Published Online: October 4, 2017. literacy measurement: a proposed research agenda. doi:10.1001/jamasurg.2017.3835 3. Pleasant A. Advancing health literacy J Health Commun. 2011;16(suppl 3):11-21. measurement: a pathway to better health and Conflict of Interest Disclosures: None reported. health system performance. J Health Commun. 2014;19(12):1481-1496. doi:10.1080/10810730.2014 jamasurgery.com (Reprinted) JAMA Surgery February 2018 Volume 153, Number 2 143 © 2017 American Medical Association. All rights reserved.

Journal

JAMA SurgeryAmerican Medical Association

Published: Feb 4, 2018

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