Patients with limited health literacy are more likely to misunderstand medication instructions and have difficulty demonstrating the correct dosing regimen. Limited health literacy is associated with increased healthcare costs and worse health outcomes, including increased mortality.

Poor health literacy is a silent and ubiquitous health care issue, and the field of neurosurgery is particularly prone to the consequent adverse effects. Failure to address low health literacy has several detrimental health and economic consequences, and numerous policies have been initiated to address these. Better facilitating patient understanding of neurosurgical disease, treatment options, and care surrounding the operative period may have a positive impact on the health care economy and ultimately achieve improved outcomes for patients.

Deyo et al. (8) demonstrated a reduction in the adverse impact of inadequate health literacy in the neurosurgical field. The impact of an interactive videodisc program that informs patients of their treatment options for back surgery on patient outcome and surgical choices was evaluated. The program helped facilitate decision making and ensured informed consent. It also reduced surgery rates for patients with herniated disks. The authors of this study also implemented the use of patient-oriented multimedia to augment comprehension and advocated a similar strategy for other clinicians. Further commitment is needed to put health literacy at the forefront of improving health care and reducing health expenditures, especially in neurosurgery.

Paasche-Orlow et al. (18) suggested 3 principles to ameliorate health literacy disparities. The first is to promote productive interactions. Clinicians need to develop better communication abilities and take appropriate measures to ensure adequate comprehension of health information. Educating youth and establishing health literacy standards in the educational system can help improve existing and future health literacy rates. Incorporating health literacy classes as a component of training for health professionals and in studies of preventive services can increase awareness among providers, facilitating better communication and quality of care (19). Additionally, transmitting complex ideas can be aided with the use of technology platforms. Yin et al. (25) investigated the plausibility of a pictogram-based intervention program to reduce medication administration errors. The authors found that when the intervention was used as part of medication counseling, there was a decrease in medication dosage errors compared with standard medication counseling.The second principle is concerned with addressing the organization of health care. Paasche-Orlow et al. advocated patient-centered care, streamlined access to health care, and incentives to promote collaboration to address the needs of the health illiterate population. The U.S. government created and enacted several major policies that address this principle to diminish the adverse effects of poor health literacy. The first is the Affordable Care Act, which stipulates that health plans and insurers must provide understandable and clear health information regarding coverage and benefits (11). Because most Americans receiving coverage through the new legislative act have limited health literacy, standardized information about health care would greatly assist these Americans in making better-informed health decisions (15). Another policy is the National Action Plan to Improve Health Literacy (22). This is the first plan of its kind to create health literacy goals for the entire country. It intends to provide all Americans with access to accurate health information, deliver patient-focused services, and support learning and skills that improve health. All of these acts and policies have the potential to improve 3 keys to health care: access, quality, and cost.The third principle from the study by Paasche-Orlaw et al. involves establishing an objective and sincere voice for better delivery of health information to the community. Individuals may have appropriate health literacy levels, but other personal or environmental factors can contribute to a lower understanding of vital health information. Ito (9) analyzed Vietnamese refugees who tested positive for inactive tuberculosis and their response to prophylactic tuberculosis treatment. Ito found that the immigrants were more hesitant to complete the medication regimen because the side effects were too “hot.” Instead, the immigrants preferred Asian herbal medications as they were considered “cooling.” Von Goeler et al. (23) investigated diabetes self-management among Puerto Rican adults with type 2 diabetes and found that the participants regularly self-monitored their blood glucose levels. However, they did not use that information to control their diabetes properly because of financial and social barriers such as competing family concerns. Situations such as these call for a voice, a cultural broker, who understands the environmental obstacles to comprehending and using health information fully.

Koh et al. (11) detailed a cycle of crisis care elaborating the nature of high medical costs, possibly resulting from fear and denial. First, an individual is in need of medical help, so he or she goes to a physician's office where the staff asks the individual to fill out a complex and confusing form. The physician examines the patient and explains the condition and treatment options using medical jargon. Numerous prescriptions, laboratory tests, and referrals are given without confirmation of the patient's comprehension. The staff sends the patient home with complicated instructions. Inevitably, the patient may consume medication incorrectly or miss follow-up appointments, and his or her condition worsens. Eventually, the patient presents to the emergency department, and the hospital staff develops a new treatment plan. Again, no one confirms the patient's understanding. When the patient is discharged, he or she is likely to get sick again and repeat the cycle (11)