Continence Coach: A Call to Action: Improving the Health Literacy of Americans

Perhaps this very instant is your time. — Louise Bogan, Pulitzer Prize-winning poet (1897–1970)

  During the last US presidential election and in its aftermath with the recent passage of the Health Care and Education Reconciliation Act of 2010, there was a great deal of discussion regarding universal healthcare coverage and problems of the uninsured. Regardless of your political leanings on the topic, we need to do a better job of providing high-quality healthcare with improved outcomes, better safety, and greater cost effectiveness. A fundamental aspect of these lofty goals is health literacy. The World Health Organization (WHO) considers health promotion essential to achieving success in providing good, primary healthcare.¹ Rather than limiting health promotion strategies to a specific health problem or set of behaviors, the WHO broadly applies health promotion principles to a variety of population groups, risk factors, diseases, and settings. This is because the WHO views health promotion and the associated efforts put into education, community development, policy, legislation and regulation, as valid for preventing communicable diseases, injury and violence, and mental problems as they are for preventing noncommunicable diseases. That’s the global picture.

  In the US, despite the noble efforts of, for example, the American Public Health Association (APHA) through its section on Health Promotion and Health Education,² the National Patient Safety Foundation reports a number of alarming statistics about the gap between health promotion as it exists and the health literacy of the American public³:

• Annual healthcare costs for individuals with low literacy skills are four times higher than those with higher literacy skills⁴;
• Only about half of all patients take medications as directed. Problems with patient adherence to medical advice, as well as with medical errors, are due (at least in part) to poor understanding of healthcare information⁵;
• Patients with low literacy skills were observed to have a 50% increased risk of hospitalization, compared with patients having adequate literacy skills.⁶

  The gulf widens further when we examine the disproportionate numbers of minorities and immigrant populations estimated to have literacy problems⁷ — namely, 50% of Hispanics, 40% of African Americans, and 33% of Asians. Private philanthropy organizations such as the Natividad Medical Foundation in Monterey, CA are working aggressively to create a replicable, model safety net hospital through expanded HIV/AIDS awareness and care, elevated maternal and neonatal care, and initiatives in palliative pain management and bereavement care services for local residents. Even foreign governments have stepped in to help close the gap in health literacy and resulting disparities, as both the Mexican and Guatemalan Consulates currently are hosting health fairs around the US for Spanish-speaking immigrants to this country.

  Although at least 12 major institutions offer doctorates in public health and promotion in an effort to increase the number of educated professionals who might improve policies and enrich programs, it is frontline healthcare providers — especially nurses — who will ultimately fill the void as patient educators responsible for raising health literacy.

  Recognizing this, the National Association For Continence (NAFC) has established a new award to specifically spotlight nurse practitioners and physician assistants who exhibit patient-centered leadership. The inaugural NAFC Rising Star Award will be presented during the 2010 meeting of the American Urological Association (AUA) in San Francisco to acknowledge an individual who has imparted knowledge and encouragement to patients; gone beyond the call of duty to advocate for patients; spent time to listen, hear, and empathize with patients to elevate the status afforded to bladder and bowel control problems and related pelvic floor dysfunction; offered innovative and creative contributions to improve patient care in the practice setting; and provided positive, professional influence, guidance, and support of colleagues in a leadership fashion. The NAFC’s 54 Continence Care Champions named over the past decade, including Mikel Gray, Marta Lee Krissovich, and Katherine Moore from the WOCN, are making the nominations. The award is sponsored by Pfizer.

  The US needs healthcare practitioners who lead by example. Keep the Rising Star Award qualifications in mind as you provide continence care and raise the level of health literacy among your patients.

This article was not subject to the Ostomy Wound Management peer-review process.

1. World Health Organization. Available at:www.who.int/healthpromotion/en/. Accessed April 9, 2010.

2. Public Health Education and Health Promotion, section of the American Public Health Association, Available at: www.apha.org/membergroups/sections/aphasections/phehp/. Accessed April 9, 2010.

3. Partnership for Clear Health Communication at the National Patient Safety Foundation™. Available at: /www.npsf.org/askme3/pdfs/STATS_GLANCE_EN.pdf. Accessed April 9, 2010.

4. Weiss BD, ed. 20 Common Problems in Primary Care. New York, NY: McGraw-Hill, Inc.;1999:468–481.

5. Baker DW, Parker RM, Williams MV, et al. The health care experience of patients with low literacy. Arch Fam Med. 1996;5(6):329–334.

6. Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. Journal of Gen Intern Med. 1998;13(12):791–798.

7. Potter L, Martin C. Health Literacy and Understanding Medical Information Fact Sheet. Center for Health Care Strategies, Inc. Available at: www.chcs.org/publications3960/publications_show.htm?doc_id=291711. Accessed April 9, 2010.