One in three middle-aged American adults ages 35 to 64 cannot consistently read prescription instructions correctly, understand medical forms, or recall details from doctor visits involving chronic condition diagnoses, according to new research. These skills, often referred to as health literacy, are important for managing common chronic conditions.

The study included 942 adults receiving care at Northwestern-affiliated hospitals and federally qualified health centers throughout Chicago. Participants’ average age was 52 and 60% were women. They managed on average 2.1 chronic conditions and 5.6 prescribed medications.

Participants completed interviews and hands-on tasks, such as interpreting prescription labels and recalling physician instructions after watching a clinical video in which they were diagnosed with gastroesophageal reflux disease.

Health literacy was assessed using the Newest Vital Sign; health self-management skills using the Comprehensive Health Activities Scale Short Form; and self-reported physical function using the Patient Reported Outcomes Measurement Information System Physical Function Scale.

The analysis found that 32.5% had limited health literacy skills. Lower health literacy was linked to lower income, less education, and unemployment. Those with poorer skills had more chronic conditions, were prescribed more medications, and performed worse on cognitive testing.

"This work is not about pointing out what people can't do, but rather, can we confuse patients less?" said lead author Abigail Vogeley, a doctoral student at the university’s Feinberg School of Medicine. "We didn't think the problem was going to be this pervasive, but to think that people are reaching their mid-to late-30s and 40s, and they haven't been onboarded properly to perform basic personal health tasks is pretty powerful."

Currently, many patient materials are written at a high school or college level. The authors recommend simplifying health information using plain language at a 6th-to-8th grade level.

Senior author Michael Wolf, also at Feinberg, emphasized the broader implications. "Billions are spent developing drugs, but far less is invested in helping patients use them correctly. Improving understanding could significantly improve outcomes and reduce harm."

To download the full study, published in the Journal of General Internal Medicine, click here