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Quality Resource Guide –
Oral Health Literacy:
A Guide for the Dental Office
www.metdental.com
Poor health literacy is costly! Approximately $200
billion dollars are spent each year in increased
health care costs due to poor health literacy.
4
In a systematic review of 96 studies comparing
health literacy and health care outcomes, low
health literacy was consistently associated with
more hospitalizations, more emergency room
trips, lower use of preventive services such
as mammography screening, failure to take
medications as prescribed, poorer overall health
status, and higher death rates among elderly
patients.
6
Importance of OHL
A
basic level of OHL is essential for
patients to prevent and manage their
dental diseases. Compared to adults
with high OHL levels, those with low OHL levels
are less likely to appreciate the importance of
preventive measures (e.g., fluoridation), practice
effective home oral care, and select appropriate
dental treatments.
2
Those with poor OHL skills
are also more likely to avoid care, have more
extensive decay and periodontal diseases, and
have overall poorer oral health compared to
those with high literacy levels.
2-4
Recent surveys
conducted in Maryland
7
and Florida
8
revealed that
adults with low OHL reported less satisfaction
communicating with dental personnel, lower
patterns of regular dental care, and lower self-
rated oral health status compared to participants
with high OHL.
Patients must have the knowledge, skills and
motivation to engage in preventive self-care
activities, seek dental care when needed, make
informed decisions regarding their treatment
options, and follow-up appropriately after dental
visits.
Effective communication is the key to
compating low OHL.
Populations at Risk for Low OHL
W
ho is at risk for low OHL?
Studies
are beginning to identify selected
segments of the general population
that might be at risk for low OHL.
The following
risk groups have been identified.
The Elderly
- OHL can decline with age.
9
Poor hearing, sight and speech can make
communication difficult for elders.
Polypharmacy
can reduce the alertness and reasoning abilities
of older patients.
Clinical depression, a common
problem in the elderly, can cause individuals
to disengage from conversation.
Older adults
may wrongly view oral problems as part of the
natural aging process, and may regard dentists as
authority figures who should not be questioned.
Dental team members must be aware of these
physiological, psychological and behavioral
barriers when sharing health information with this
growing segment of the population.
Young Children and Their Caregivers
- T
he health literacy of caregivers is a key
determinant of health care and outcomes in
children.
Therefore, OHL studies have begun
to examine the literacy levels of parents and
caregivers of young children.
10-11
A study of nearly
1200 caregiver/child pairs from a low-income
population in North Carolina showed that children
under the age of 6 years with poor oral health
behaviors (e.g., bottle use at night and no daily
toothbrushing) were more likely to have caregivers
with low OHL than children with good oral health
behaviors.
10
An investigation of young children with
severe dental needs revealed that they were more
likely to have a caregiver with low OHL than those
with mild-to-moderate needs.
11
Culturally and Linguistically Diverse
Populations
- Individuals whose primary
language is not English, as well as other culturally
diverse populations, are also at a risk for low
OHL.
12
The 2012 U.S. Census reported that over 4
million individuals of age 5 years and older were
born in another country, an increase of nearly
300% since 1980.
13
Approximately 85% of those
individuals spoke a language other than English at
home, and of these, approximately 25% had little
or no English-speaking ability.
14
The rapidly rising
number of culturally and linguistically diverse
individuals in this country poses a challenge
to communicating important health information
effectively.
An OHL Action Plan to Improve
Patient Communication
H
ealthcare providers have a responsibility
to provide information clearly to
patients and to check that their patients
understand the information given to them.
How
can dentists know if there are barriers to OHL in
the office?
How do they know if the office staff’s
communication skills are effective? How can they
determine if patients understand the information
and instructions discussed in the office?
To assist healthcare providers in addressing
these questions, the Agency for Healthcare
Research and Quality (AHRQ) has developed
an online toolkit PDF entitled “Health Literacy:
A Universal Precautions Toolkit” (http://www.
ahrq.gov/professionals/quality-patient-safety/
quality-resources/tools/literacy-toolkit/
healthliteracytoolkit.pdf).
15
The AHRQ toolkit
contains a one-page guide for jump-starting
a communication review and implementation
process, as well as a comprehensive guide
with step-by-step instructions for generating,
implementing and evaluating an action plan in
a healthcare setting.
The toolkit contains short
(2-to-5 page) briefs, or “tools”, on 20 relevant
topics covering areas such as assessing spoken
communication skills, obtaining patient feedback,
and guiding staff training.
The toolkit is designed for medical personnel
but can easily be adapted for use in the dental
practice. A nine-step action plan, created using
information in the toolkit can be used by the
dental office to identify, carry out and re-assess
changes for improved communication.
The
action plan (Table 1) is discussed in detail below.
Consult the toolkit for additional suggestions and
for other tools that may be helpful in your office.
Step 1: Raise OHL awareness among dental
team members.
OHL affects the ability of
patients to seek dental care, understand health-
related information, and follow home care
instructions. Therefore, OHL is a concern for
both administrative and clinical members of
the dental team.
Generating awareness of this
issue is a necessary step for effecting change.
