Improving Oral Health Literacy to Reduce Health Disparities

Health literacy plays an important role in whole-person care because it influences access to and quality of oral health care. Improving oral health literacy is essential since we can prevent most oral diseases.¹

Healthy People 2030 defines health literacy in two aspects: personal and organizational. “Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” ^2,3,4

In 2018, Kathryn Atchison and her colleagues proposed the twice-modified Rainbow Method of Integrated Care conceptual model, which incorporates health literacy at four organizational levels: the clinic, the professional, the organization, and the system.⁵ The American Medical Association and the Agency for Healthcare Research and Quality suggest using a "universal precautions" approach to health literacy, treating everyone as if they have limited oral health literacy skills.⁶

Organizations can promote oral health literacy through various interventions:²

• Create a safe, inclusive, and patient centered environment.^1,6
• Provide language assistance.^3,6
• Make health care information simple, easy to understand, readily accessible, and actionable.^1,3,4,7,8
• Involve individuals with limited health literacy when creating educational materials or programs.^1,4
• Use culturally sensitive communication channels that meet the needs of a wide range of health literacy skills.^7,8
• Encourage patients to take a more active role in their care, including utilizing preventive services and managing chronic conditions.³
• Promote shared decision-making to improve patient satisfaction and adherence.³
• Raise health literacy awareness among health care professionals.^3,4,7
• Develop clear communication strategies with patients using plain language, visual aids, motivational interviewing, and teach-back methods.^1,6
• Use plain language to clearly communicate the cost of available health services.⁴
• Utilize community health workers to improve health literacy.⁵
• Include health literacy promotion in the organization’s mission.⁴
• Integrate oral health into overall health education.

Health literacy encompasses several types, including functional, interactive, and critical health literacy.⁵ Nutbeam defines functional literacy as “having sufficient basic skills in reading and writing to be able to function effectively in everyday situations.”⁹ Patients in an oral health care setting need this literacy to complete health forms or know about informed consent.⁵ Nutbeam defines interactive literacy as “more advanced cognitive and literacy skills which, together with social skills, can be used to actively participate in everyday activities, to extract information and derive meaning from different forms of communication, and to apply new information to changing circumstances.”⁹ This type of health literacy is important for patient communication techniques like the teach-back method.⁵ He defines critical literacy as “more advanced cognitive skills which, together with social skills, can be applied to critically analyze information, and to use this information to exert greater control over life events and situations.”⁹ Patients and oral health care professionals need this type of literacy for shared decision-making about care.⁵

Patients need all these types of literacy to make informed decisions about their oral health.^2,5 By implementing interventions to enhance these different types of health literacy, we can help reduce oral health disparities and promotes oral health equity.^1,2,3,4

Author Bio

 

Anupama Grandhi, BDS, DDS

Dr. Anupama Grandhi is an Associate Professor in the Department of Oral & Maxillofacial Surgery at the School of Dentistry and Assistant Professor in the Department of Pathology & Human Anatomy at the School of Medicine. She is a Diplomate of the American Board of Oral and Maxillofacial Pathology and a Fellow of the American Academy of Oral and Maxillofacial Pathology. Her research interests include oral cancer and wellbeing.

References

1. https://www.who.int/news-room/fact-sheets/detail/oral-health
2. https://health.gov/healthypeople/priority-areas/health-literacy-healthy…
3. Santana S, Brach C, Harris L, Ochiai E, Blakey C, Bevington F, Kleinman D, Pronk N. Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract. 2021 Nov-Dec 01;27(Suppl 6):S258-S264. doi: 10.1097/PHH.0000000000001324. PMID: 33729194; PMCID: PMC8435055.
4. https://www.cdc.gov/healthliteracy/learn/
5. Improving America’s Oral Health Literacy. https://www.deltadentalinstitute.com/content/dam/delta-dental-policy/pd…
6. California Department of Public Health Oral Health Literacy Tool Kit. https://oralhealthsupport.ucsf.edu/sites/g/files/tkssra861/f/wysiwyg/CD…
7. Brach C, Harris LM. Healthy People 2030 Health Literacy Definition Tells Organizations: Make Information and Services Easy to Find, Understand, and Use. J Gen Intern Med. 2021 Apr;36(4):1084-1085. doi: 10.1007/s11606-020-06384-y. Epub 2021 Jan 22. PMID: 33483812; PMCID: PMC8042077.
8. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Roundtable on Health Literacy. Integrating Oral and General Health Through Health Literacy Practices: Proceedings of a Workshop. Wojtowicz A, Olson S, editors. Washington (DC): National Academies Press (US); 2019 Jul 31. PMID: 31393688.
9. Don Nutbeam, Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century, Health Promotion International, Volume 15, Issue 3, September 2000, Pages 259–267, https://doi.org/10.1093/heapro/15.3.259