Successful health care for patients depends on clear communication. However, in most parts of the world, little attention has been given in enabling patients to understand the level of health and functional literacy required in making appropriate medical decisions. Shared decision-making between healthcare practitioners and patients is needed to achieve the desired health outcomes ( Mackey et al., 2016) . As such, appropriate literacy intervention programs such as teach-back should be utilized. Many patients across the world do not know how to read and write, affecting their functional literacy and health knowledge. The problem is complex, and patients in such categories experience myriad of challenges. Notably, most of them fail to engage in disease prevention methods such as immunization, management of chronic diseases, and failure to diagnose ailments early. The issues above are associated with adverse economic impacts due to increased costs of visits to hospitals, admissions, and emergency health interventions. The paper will discuss similarities and differences between health and functional literacy, assessment tools, impacts of low literacy on client interaction in healthcare, effects of weak health and functional literacy on healthcare cost, evidence-based strategies, and its importance in health assessment.
Compare and Contrast Health and Functional Literacy
Health literacy entails the ability of an individual to have the capacity to obtain, process, and understand essential information related to their health required in making appropriate wellbeing decisions. For instance, an individual with adequate health literacy can read and comprehend critical health-related materials such as appointment slips and prescriptions. Functional literacy is associated with one's practical skills required to read and write to engage in real-life situations ( McCormack et al., 2017) . It is aimed at enabling people to function effectively in society. Functional and health literacy have several similarities and differences in general. On similarities, both functional and health literacy are achieved through educational opportunities. Education helps people acquire relevant skills and knowledge that can be applied in the interpretation of health status and ways of engaging effectively on issues affecting the community. Both functional and health literacy have a positive economic impact on an individual. For instance, people with functional literacy can better education, housing, income level, and occupation. Similarly, people with adequate health literacy abilities have access to and understand medical care they require ( McCormack et al., 2017) . The differences existing between functional and health literacy is related to literacy exposure in functional and health settings. Health literacy is not related to general reading ability or number of years in which one spends in school but exposure to the health care environment. However, functional literacy is related to general reading and the period in which one was exposed to educational settings.
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Tools Used in Assessing Health Literacy and Its Importance
Assessment of the health literacy of clients can be done using either Rapid Estimate of Adult Literacy in Medicine (REALM) or Basic Skills Assessment Initial Tests (BSAIT) ( Altin et al., 2014) . REALM is a word recognition test that consists of items used in identifying people with poor literacy skills. The assessment tool is used in evaluating the pronunciation and word recognition ability of the patient. The REALM involves subjecting the patient to read aloud 66 medical words that have been arranged in increasing order of difficulty. Patients are awarded one point for each word correctly pronounced and nil for skipped or mispronounced. The assessment period takes between 2 to 3 minutes to complete ( Altin et al., 2014) . A score of below 59 is considered low health literacy, whereas above 60 scores is considered adequate health literacy skills. Basic Skills Assessment Initial Tests (BSAIT) provides a measure of the general literacy of a patient. The entire assessment process takes 20 minutes, and patients are subjected to a nine-page worksheet, which has 72 questions ( Chinn & McCarthy, 2013) . BSAIT tests a patient's ability to read comprehension using various everyday scenarios, such as understanding different types of fruits. The patient's literacy is measured based on the number of correct pronunciations of comprehension given.
Incorporation of both functional and health literacy screening among patients is essential in healthcare. Integration helps in the development of skills that are critical in the healthcare setting. The knowledge obtained from incorporating the two literacy domains helps in the extraction of information that can be applied in managing the changing circumstances associated with the patient's condition. For example, in the screening of patients with diabetes, functional and literacy knowledge can be used to develop a program for management of the condition. It also allows the patient to better describe his or her condition by utilizing functional literacy and, in return, using health literacy; the physicist can confirm the condition through interactive ideologies. Notably, the health care practitioner can demonstrate the issue affecting the condition by utilizing functional and health literacy interchangeably. Incorporation of health and functional literacy also improves patient-provider communication ( Altin et al., 2014) . Such helps promote discussion between patient and provider, making the patient feel more empowered to voice concerns that are vital for screening purposes. For patients with chronic conditions, integration of health and functional literacy offers a room for a demonstration of self-care activities, and verifying health behaviors that the patients need to practice. Nonetheless, the integration between functional and health literacy also helps in building safe and patient-centered health practice. Addressing the patient's health concerns should be communicated clearly, concisely, and consistently using both literacy methods. The mechanism helps identify if the patient is struggling to understand medical instruction and provide a framework that can be used for intervention.
Impact of Low Health Literacy On Interaction With Clients
Low health literacy has been associated with poor health outcomes and patient satisfaction. In 2003, low health literacy in the USA was a significant challenge, especially among adults ( Chinn & McCarthy, 2013) . It is approximated that 80 million adults had limited experienced health literacy challenges. The negative influence of limited health literacy had overall poor outcomes and satisfaction among patients. Notably, the patients with lower health literacy were associated with increased cases of being admitted in the emergency department as well as increased cases of admission. Nonetheless, such patients were constantly in hospital for medication purposes, less screened on lifestyle diseases, and had lower rates of immunization. The leading causes of frequent hospitalization and admission to emergency units result from their inability to take medication properly and interpreting health messages and labels correctly. Patients with low health literacy had a poor understanding of various health promotion, disease control, and chronic disease management strategies. For instance, Medicare enrollers with low health literacy did not engage in health promotion methods, such as having a mammogram and pam smear for more than two years. However, patients with health literacy followed the protocols in place related to intervals of screening for lifestyle diseases. Nonetheless, low health literacy patients were not receiving immunization for diseases such as pneumonia and influenza. Similarly, patients with low health literacy had a high level of chronic disease complications. Health literacy plays a vital role in the management of chronic diseases. Patients learn on ways of assessing and understanding health information, including complex medical regimen, plan, and lifestyle adjustment required in the management of chronic conditions. However, the lack of data due to low health literacy prevents patients with chronic diseases from engaging in effective management. Chinn & McCarthy (2013) argue that 47% of patients have chronic diseases, and as a result, individual responsibility in the management of the illness is required. However, low literacy health literacy rates, especially among minority ethnic groups, low-income earners, and low formal education, experience difficulties in self-management.
Effects of Low Health Literacy and Low Functional Literacy on Healthcare Cost
Low health and functional literacy have economic consequences for individuals and society due to subsequent high healthcare costs. It leads to high spending among patients to meet healthcare needs. Altin et al. (2014) view that patients with functional and health literacy levels reported poor health status, making them less likely to utilize preventive care. The problem resulted in increased cases of hospital visits due to negative disease experience, a process that is quite expensive. Notably, it is estimated that inpatient spending for a patient with limited functionality and health literacy increased by $993 million in the USA in 2018. Further, Mackey et al. (2016) reiterate that Medicare and Medicaid spend relatively $ 58 billion in paying for medication for limited functional and health literacy. The leading causes of the increase in the cost of care are the failure of such a group of people to comply with prescribed self-care medical regimen, treatment errors, and lack of skills required in navigating the healthcare system.
The high cost of healthcare among patients with low health and functional literacy is due to the absence of health insurance. Lack of knowledge has hindered many people, especially from minority groups, from accessing medical insurance. In case of illness, they are forced to make cash payments, which are burdensome financially compared to payment using insurance schemes. It also leads to an increase in medical burden cases due to frequent hospitalization and admission in the emergency unit. Illiterate people cannot understand the importance of health promotion methods, such as early screening and diagnosis of conditions like diabetes and hypertension ( Woods & Chesser, 2017) . Also, people with low health and functional literacy do not understand the necessity of immunization. The challenges result in constant ailments, which hurt their financial resources. For example, people might not be aware of regarding need to immunize for pneumonia and influenza, which are offered free of charge by the government. The problem results in the emergence of health conditions later in one's life, leading to a need to seek medical attention, which is a costly endeavor. Nonetheless, low health and functional literate individuals have higher utilization of expensive healthcare services. Due to a lack of information regarding the need to visit medical practitioners early for diagnosis and control of diseases, such people visit the hospital when the health condition has already deteriorated. To mitigate the condition, one has to use inpatient admission or emergency services, which are quite expensive.
Evidence-Based Teaching Strategies
Evidence-based teaching strategies play a vital role in reinforcing the patient's understanding of their health issues. One of the methods in which a doctor can use is the teach-back mechanism. The teaching strategy involves allowing the patients to explain health information using their own words. The technique is widely used in inpatient, primary care, and patient in the emergency department setting. It involves short-term instructions to programs that can be covered within 20 hours ( McCormack et al., 2017) . The patient's health literacy is achieved through a complicated process that involves obtaining, analyzing, and communicating health information. The teaching technique is used by practitioners to confirm if they have explained healthcare information to a patient in a way that is well understood. The method creates a learning environment for non-shameful and safe patients by eliminating ambiguous medical terminologies and transcribing it to language that the patient can easily understand and interpret while being involved in the care process. The strategy allows the patient to ask appropriate questions, thus reducing medical errors. The process helps the patient in understanding medical instructions. Nonetheless, the method will enable practitioners to re-phrase and adjust their explanations so that patients fully understand.
The healthcare practitioner can also utilize community connections to teach low health literacy to improve patients' health outcomes ( Woods & Chesser, 2017) . Practitioners are encouraged to partner with the community in disseminating important health information. The teaching covers issues such as the need for the community to eat nutritious food, exercise, or reminder to get the vaccination for seasonal flu. The campaigns could as well cover on initiatives like screening for prostate cancer and other common chronic diseases. Healthcare providers can partner with community organizations such as religious organizations, local libraries, and community colleges for health teaching literacy purposes.
Importance of Evidence-Based Teaching Strategies to Health Assessment
Evidence-based teaching strategies are essential in health assessment. Effective interventions such as building community connections and teach-back techniques are essential in mitigating low health literacy. Poor health literacy is associated with suboptimal use of health services, a method with negative health outcomes. The techniques will help improve health assessment by reducing the consequences of low health literacy factors such as lower vaccination rates, poor cases of health screening on mammography, increased admission to emergency rooms, and increased mortality rates. Low health literacy has adverse effects on the hospital and individuals. However, the mitigation factors help improve patients' economic wellbeing by equipping and empowering them to understand better and manage their health needs. Nonetheless, the teaching techniques facilitate the reduction of the cost incurred in treating patients whose health conditions are associated with inadequate health literacy. In the USA, low health literacy leads to annual spending of between $106 and $238 for emergency room visits and health cases that are preventable ( Mackey et al., 2016) . Evidence-based teaching strategies also help in the improvement of quality of care for patients. The techniques offer a platform through which the patients can be taught ways of decreasing healthcare costs, managing their health, and promoting quality outcomes.
Conclusion
Health and functional literacy are two critical parameters in health care. Despite that, functional literacy is viewed as practical skill in reading and writing; it affects one's knowledge of health needs. The exposure of an individual to a healthcare setting is crucial in obtaining the knowledge required in understanding issues related to health decision-making. Low health and functional literacy cause high healthcare costs. Notably, illiterate people in terms of education and health are not informed about important matters concerning health promotion such as screening of chronic diseases, immunization, and early diagnosis of health issues. The problems hurt the patient since it causes high spending due to hospitalization for conditions that could have been detected and treated early before its progression. Health literacy can be assessed using REALM and BSAIT tools. The tools are used in gauging the overall literacy ability of a patient. Evidence-based strategies such as teaching back and building community connections should be implemented to reduce the effects of low health literacy. The strategies are geared towards empowering patients with knowledge on how to improve their health.
References
Altin, S. V., Finke, I., Kautz-Freimuth, S., & Stock, S. (2014). The evolution of health literacy assessment tools: a systematic review. BMC public health , 14 (1), 1207. https://doi.org/10.1186/1471-2458-14-1207
Chinn, D., & McCarthy, C. (2013). All Aspects of Health Literacy Scale (AAHLS): developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings. Patient education and counseling , 90 (2), 247-253. https://doi.org/10.1016/j.pec.2012.10.019
Mackey, L. M., Doody, C., Werner, E. L., & Fullen, B. (2016). Self-management skills in chronic disease management: what role does health literacy have?. Medical Decision Making , 36 (6), 741-759. https://doi.org/10.1177%2F0272989X16638330
McCormack, L., Thomas, V., Lewis, M. A., & Rudd, R. (2017). Improving low health literacy and patient engagement: a social ecological approach. Patient education and counseling , 100 (1), 8-13. https://doi.org/10.1016/j.pec.2016.07.007
Woods, N. K., & Chesser, A. K. (2017). Validation of a single question health literacy screening tool for older adults. Gerontology and geriatric medicine , 3 . https://dx.doi.org/10.1177%2F2333721417713095
