NSG 3200- Health Literacy and Disparities within Diabetes Mellitus Essay

NSG 3200- Health Literacy and Disparities within Diabetes Mellitus Essay

Introduction

Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health care decisions” (Healthy People 2020). When dealing with one’s health, a patient should be able to read and understand any essential health related material provided from their medical providers. Individuals with low health literacy do not have the best healthcare outcome because they struggle with obtaining and applying health information. Low health literacy is more prevalent among ethnic minorities, older people and those with chronic conditions, specifically diabetes. In addition to low health literacy, there is evidence that racial and ethnic minorities tend to receive lower quality of care than non-minorities. Patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases causing a major health disparity (Egede, 2006).  The purpose of this paper is to discuss such disparities and what can be done to ensure equality among health literacy while decreasing disparity within healthcare. NSG 3200- Health Literacy and Disparities within Diabetes Mellitus Essay

Health disparities

                The Institute of Medicine (IOM) report on unequal treatment concluded “racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable” (Egede, 2006).  Disparities in health care, as defined by the IOM, includes racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.Whereas, barriers to health care can be defined as conditions that can restrict or prevent the access of necessary health care for vulnerable populations.  Existing barriers to attaining health care services often lead to disparities which in turn lead to differences in life expectancy, health status and a higher prevalence of certain chronic diseases (HealthyPeople.gov, 2012).  Low-income families identified lack of insurance coverage, poor access to services, and unaffordable costs as the 3 major barriers to accessing health care. Even when families can obtain insurance, they still face obstacles such as unaffordable co-pays, deductibles, and prescriptions. NSG 3200- Health Literacy and Disparities within Diabetes Mellitus Essay

                Impact

Significant diabetes disparities exist among racial/ethnic minorities in both health outcomes and quality of care; they have higher prevalence rates, worse diabetes control, and higher rates of complications.  With the aging of the U.S. population and the rising prevalence of chronic diseases, these disparities have important public health implications for the near future. Within the past two decades, significant public resources have been devoted to developing and evaluating interventions designed to improve diabetes care in the general population.  The federal government, insurance companies, and health care delivery systems have invested heavily in QI programs.  These programs have the potential to improve health disparities for racial/ethnic minorities. Recent data from Medicare Managed Care beneficiaries show that diabetes care is improving overall and that racial disparities may be improving as well (Peek, Cargill, & Huang, 2017).The Veterans Health Administration (VHA) has also implemented several QI initiatives and recently reported measures of diabetes care and diabetes health outcomes that are much higher than the national average, including annual rates of HbA1c testing and eye examinations at 93% and 91% and rates of control of diabetes and dyslipidemia at 83% and 86%.  Some studies suggest that these generalized QI efforts within the VHA system have diminished or eliminated diabetes health disparities among racial/ethnic minority populations (Wilkes, Bordenave, Vinci, & Peek, 2013). NSG 3200- Health Literacy and Disparities within Diabetes Mellitus Essay

Health Literacy

                Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health care decisions” (Healthy People 2020). Therefore, the health literacy of patients with diabetes describes not only their ability to read insulin storage instructions, eye and foot screening appointment slips or perhaps the glucose meter manual, but also to seek out diabetes-related information on diet and lifestyle.Without proper understanding of a carbohydrate diet and glucose monitoring, a diabetic patient can suffer from hyperglycemia or hypoglycemia, both of which can be fatal.

Inadequate health literacy is common in the US; according to the National Assessment of Adult Literacy, over a third of U.S. adults have basic or below basic health literacy and would have difficulty managing common health-related tasks.  “Limited health literacy poses a significant economic burden to our society, with national estimates indicating that low health literacy costs the U.S. healthcare system from $106 to $238 billion each year.  Accordingly, health literacy is a national priority; Healthy People 2020 goals have called for significant improvements in health literacy to advance the health of the population” (Bailey, et al., 2014). NSG 3200- Health Literacy and Disparities within Diabetes Mellitus Essay

Assess and Improve Understanding

Adequate health literacy in the context of diabetes includes a collection of skills that are critical to patients for managing their condition and navigating the health care environment. These include: cultural and conceptual knowledge; aural and oral literacy (i.e., listening and speaking); print literacy (i.e., writing and reading); and numeracy (i.e., the ability to understand and use numbers). Health literacy skills specific to diabetes include reading labels on pill bottles, following written or verbal directions, and comprehending appointment information, educational brochures, and informed consent documents.Numeracy, is fundamental to diabetes self-management in understanding medication dosing, health insurance information, test results, insulin requirements, and interpreting food labels. To date, however, no single measure of health literacy in diabetes has adequately captured the full range of skills described above(Bailey, et al., 2014).

The ability to communicate effectively with patients who have low health literacy depends on our ability to recognize this problem and to create a patient-centered and shame-free healthcare environment. Because of the shame and embarrassment these patients experience, they often use their well-developed coping skills to mask their limited literacy. Although many reading- and comprehension-assessment tools are available, there is debate whether or not these tools should be used clinically. NSG 3200- Health Literacy and Disparities within Diabetes Mellitus Essay

Knowing whether a patient has low health literacy skills is very important. This knowledge enables the medical provide to match verbal instructions and the readability level of materials to the health literacy skills of the patient. It may also suggest the benefits of using non-printed teaching materials, such as videotapes, audiotapes, demonstrations, models, pictograms, and other visuals.

Conclusion

                Nurses play a major role in providing leadership that meets the challenge of low health literacy and disparity in our society, both at the individual level of care and within our organizations.  One needs to know how to implement strategies to create a patient-centered, shame-free environment that enhances health literacy not only for patients with low literacy, but for all patients. Knowing how to assess a patients’ ability to read and understand health information is essential to identify the most vulnerable patients who most need help addressing their low health literacy.Furthermore, identifying and addressing the disparities within healthcare can improve the overall care of all patients but especially those with chronic healthcare issues such as diabetes. NSG 3200- Health Literacy and Disparities within Diabetes Mellitus Essay