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	Institution: STANFORD Univ Med Center  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 5 No. 6, June 1996   Archives  •  Online Features ORIGINAL CONTRIBUTIONS  This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal The Health Care Experience of Patients With Low Literacy David W. Baker, MD, MPH; Ruth M. Parker, MD; Mark V. Williams, MD; Kathryn Pitkin, MPH; Nina S. Parikh, MPH; Wendy Coates, MD; Mwalimu Imara, DMn Arch Fam Med. 1996;5(6):329-334. Abstract Objectives To understand the difficulties that patients with poor reading ability have interacting with the health care system and to identify the coping mechanisms they use to deal with these problems. Design Focus groups and individual interviews with patients who are illiterate and patients with low literacy. Setting Two large, urban public hospitals. Participants Sixty patients with marginal to poor reading abilities as measured by the Rapid Estimate of Adult Literacy in Medicine were interviewed in focus groups or individual interviews. Measurements and Main Results Patients with low literacy harbor a deep sense of shame, which is reinforced by hospital staff who become frustrated or angry when someone cannot complete a form or read instructions. Seeking medical care is intimidating for patients with low literacy because they cannot understand signs and registration forms. Many patients recounted serious medication errors resulting from their inability to read labels. To cope with these problems, the patients with low literacy rely heavily on oral explanations, visual clues, and demonstrations of tasks to learn new material. Most also use a friend or family member as a surrogate reader. Conclusions Patients with poor reading ability have important problems accessing the health care system, understanding recommended treatments, and following the instructions of providers. Because of their shame, patients with low literacy may be unwilling to disclose their problem to health care providers, and screening tests of reading ability may be necessary to identify those who need special assistance. Patients' coping mechanisms give insight into possible interventions that may improve their interactions with the health care system. Author Affiliations From the Division of General Medicine, Emory University School of Medicine (Drs Baker, Parker, Williams, and Ms Parikh) and the Department of Community Medicine, Morehouse School of Medicine (Dr Imara), Atlanta, Ga; and the Departments of Medicine (Dr Baker and Ms Pitkin) and Emergency Medicine (Dr Coates), Harbor-UCLA Medical Center, Torrance, Calif. 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