Public Health Campaigns Should De-stigmatize Low Health Literacy

Sept. 7, 2011

AUSTIN, Texas — When creating public health campaigns researchers and public policy makers should include messages to combat the perception that low health literacy equates to low intelligence, according to researchers at The University of Texas at Austin.

Michael Mackert and Brad Love , assistant professors in the Department of Advertising; Erin Donovan-Kicken , assistant professor in the Department of Communication Studies; and Katharine A. Uhle, a graduate student in the Department of Advertising, authored the study, " Health Literacy as Controversy: An Online Community’s Discussion of the U.S. Food and Drug Administration Acetaminophen Recommendations ," which appears in the most recent issue of Qualitative Health Research.

Health literacy -- an individual’s ability to obtain, process and act appropriately on health information -- has a significant impact not only on an individual’s health outcome, but the entire U.S. healthcare system. More than 90 million adults with low health literacy have limited ability to read and understand instructions on medications. As a result patients often take medications on erratic schedules and unknowingly ingest harmful amounts. Low health literacy costs the healthcare system about $69 billion per year, according to a 2004 National Academy of Sciences study.

The new University of Texas study examined public perceptions of health literacy within the context of discussions of proposed government regulation of acetaminophen. Regulation was being proposed because many consumers unintentionally overdosed on acetaminophen and damaged their liver, not realizing the drug was in both their prescription and their over-the-counter pain relievers.

The discussions took place on the news site Slashdot. Slashdot was selected because it focuses on science and technology news, has a diverse and educated community of users, and is ranked among the top 1,300 websites worldwide in terms of traffic.

The study revealed that many people overestimate the health literacy of the average health care consumer. Many linked intelligence to health literacy, suggesting people who overdosed on acetaminophen were "stupid" and deserved the outcome.

"When thinking about health literacy, many people ignore situational and socioeconomic factors, such as inability to read a medication label, or the fact that people might be dealing with complex information in stressful situations when they or their loved ones are sick," said Mackert, whose research is focused on designing health messages to reach populations with low health literacy.

"Our study merely begins to address public perceptions of health literacy. Given the prevalence of low health literacy in the U.S., research in this area might have important implications on public policy regarding the healthcare system and how those policies are communicated."

The online discussion topics in the study included the risks and benefits of acetaminophen, patient education, the possible consequences of a ban of acetaminophen, and the responsibility for taking medications safely. While most posts were neutral in tone, the most striking comments argued that those who cannot take medication properly are "stupid and deserve what they get."

This research points to numerous directions for future investigation, including continued research into public perceptions of health literacy. The findings also suggest that public health campaigns, such as the Agency for Healthcare Research and Quality and the Advertising Council’s " Questions are the Answer " campaign, could benefit from including de-stigmatizing messages to combat public perceptions that equate low health literacy with low intelligence.