Jordyn Baker 

ENGL 1010 
Dr. Haslam 
November 11, 2019 
Annotated Bibliography 

I work as an OA in an ophthalmology clinic that deals with a lot of elderly patients that 
have glaucoma or cataracts. Many of the patients don’t understand what their diagnosis, how to 
treat it, or how often they should be taking their medications. I experience this first hand when 
they tell me that the doctor didn’t do a very good job at explaining their eye drops, medications, 
diagnosis, treatment options, etc. When they don’t know how to take their eye drops properly it 
causes their eye pressure to exceed normal limits and they end up needing surgery. This could 
have been avoided if they would’ve asked the doctor questions when they didn’t fully understand 
or write down what the doctor had told them. Although this problem mainly affects elderly 
patients, not everyone always fully understands what they are told at the doctor and are usually 
too afraid or ashamed to ask questions. This leads us to the question: is the low health literacy in 
patients affecting their healthcare? 

Boodman, S. G. (2011, March 1). Helping Patients Understand Their Medical Treatment. 
Retrieved November 5, 2019, from 
https://khn.org/news/health-literacy-understanding-medical-treatment/. 
 
Sandra G. Boodman, a medical reporter for the Washington Post, talks about Americans’ 
alarmingly low levels of health literacy – the ability to obtain, understand and use health 
information. In her 2011 article, “Helping Patients Understand Their Medical Treatment,” 
Boodman talks about a study by the U.S. Department of Education that found that 36 percent of 
adults have only basic or below-basic skills for dealing with health material. Which means that 
90 million Americans can understand discharge instructions written only at a fifth-grade level or 
lower. Boodman states that studies have linked poor health literacy, which affects the elderly, the 
poor, and recent immigrants, to higher rates of hospital readmission, expensive and unnecessary 
complications, and even death. A 2007 study estimated the problem cost the U.S. economy as 
much as $238 billion annually, notes Boodman. She reports that experts predict efforts to boost 
health literacy may benefit even the minority who are proficient. ‘People worry about dumbing 
things down, Brach said, but in the research, no one has ever complained that things were too 
simple. Everybody wants clear communication,” notes Boodman. 
 
This article represents the viewpoint that low health literacy affects a patient’s healthcare 
and states that it leads to higher rates of hospital readmission, expensive and unnecessary 
complications, and even death. The author uses many credible studies to illustrate her point. The 
article is directed towards healthcare professionals that can help with this ongoing issue. This 
source is credible to its audience because she uses quotes from interviews with other health 
professionals that deal with educating patients. 
 
Engelke, Z. R. M. (2018). Patient Education: Caring for Patients with Low Health Literacy. 
CINAHL Nursing Guide. Retrieved from 
http://search.ebscohost.com.libprox1.slcc.edu:2048/login.aspx?direct=true&db=nup&AN
=T705757&site=eds-live 
 
Zeena Engelke, a registered nurse, talks about caring for patients with low health literacy. 
In her article, “Patient Education: Caring for Patients with Low Health Literacy,” she states that 
the typical adult in the United States reads at an 8th grade reading level, but health information is 
often communicated at a college level or higher. Engelke talks about how the implementation 
and evaluation of health literacy promotes increased patient education and reduces shame related 
to a patient’s inability to understand basic health information. Caring for patients with low health 
literacy involves creating an environment where patients feel comfortable talking with nurses 
about their health literacy concerns, says Engelke. She states that identifying individuals with 
low health literacy early, using strategies that promote patient understanding, and evaluating 
patient response to learning to maximize understanding. “Caring for patients with low health 
literacy occurs in all healthcare settings,” says Engelke, “including hospitals, ambulatory clinics, 
outpatient physician offices, nursing homes, and the home environment.”  
 
This article represents the viewpoint that low health literacy does affect a patient’s 
quality of healthcare as well as provides examples of how to improve this problem. The author 
has a fair amount of ethos in her writing because she is a registered nurse who has dealt with and 
researched the issue. The author directs the article to health professionals such as registered 
nurses, physicians and assistive staff members that assist in educating patients about their 
healthcare. This source is credible to its audience because it uses facts and studies from reliable 
sources in order to persuade and educate its audience. 
 
Ingram, R. R. (2018). Creating “Win-Win” Outcomes for Patients with Low Health Literacy: A 
Nursing Case Study. MEDSURG Nursing, 27(2), 132–134. Retrieved from 
http://search.ebscohost.com.libprox1.slcc.edu:2048/login.aspx?direct=true&db=ccm&A
N=129092751&site=eds-live 
 
Racquel Richardson Ingram, a registered nurse, talks about low health literacy being 
linked to low literacy as well as how to combat this. In her article, “Creating ‘Win-Win’ 
Outcomes for Patients with Low Health Literacy: A Nursing Case Study,” she states that patients 
with low health literacy may be unable to follow directions in adopting healthy lifestyle 
behaviors, participate actively in their care, self-manage their medication regimens, and follow 
treatment recommendations of healthcare team members. These deficits may contribute to 
frequent but potentially preventable hospitalizations due to poorly controlled chronic conditions, 
says Ingram. She says patients with low health literacy are much more likely to be nonadherent 
to their healthcare plans, have frequent hospital admissions, and be prone to potentially fatal 
mistakes due to their inability to obtain, process, and analyze basic health information. 
Additional concerns include consumers’ inability to evaluate unreliable Internet sources for 
medical, nutrition, and exercise information, says Ingram. In order to combat this problem 
Ingram suggests the teach-back strategy. This strategy can be used to create win-win outcomes 
for a patient with low health literacy and involves discussing the treatment plan and having the 
patient repeat care instructions to the healthcare professional to validate understanding, says 
Ingram. 
 
This article represents the viewpoint that low health literacy decreases the quality of 
healthcare for patients and gives strategies on how to combat this problem. The author has a 
good amount of ethos in her article because she is a registered nurse and she uses statistics and 
data from credible sources. The author directs the article toward health professionals, such as 
nurses, who can educate the patient and make sure they understand their treatments. This source 
is credible to its audience because it uses references of reputable sources which creates a sense of 
authority on the issue. 
 
Schub, T. B., & Uribe, L. P. M. (2017). Health Literacy. CINAHL Nursing Guide. Retrieved 
from 
http://search.ebscohost.com.libprox1.slcc.edu:2048/login.aspx?direct=true&db=nup&AN
=T904056&site=eds-live 
 
Tanja Schub, ​medical and scientific material writer, talks about what we know about 
health literacy and what we can do about it. In her evidence-based care sheet titled, “Health 
Literacy,” she states that research results link better health literacy with better health outcomes. 
Schub says a gap often exists between what healthcare professionals convey and what patients 
understand. Basic or below-basic health literacy is more prevalent in the following groups: older 
adults, minority populations, persons with low socioeconomic status, and persons with limited 
English proficiency, states Schub. Patients with basic or below-basic levels of health literacy can 
have difficulty with the following: medical terminology or “jargon,” understanding English 
treatment instructions and directions on medicine packaging, managing chronic health 
conditions, understanding the link between risky behaviors and health, locating healthcare 
providers and services, completing complex health forms, sharing medical history with 
providers, and seeking preventive health care, she says. Schubs says to help with this issue 
healthcare providers should learn about health literacy so they can share this information with 
their colleagues and help to support organizational health literacy goals. 
 
This article represents the viewpoint that better health literacy is linked to better health 
outcomes. The author has a decent amount of ethos in her writing because she has had 18 years 
of experience writing medical and scientific material. She also cites expert references in her 
writing. The author directs the article toward healthcare providers who can educate patients and 
take the time to help them understand their medical issues. This source is credible to its audience 
because it cites research from credible sources which makes the piece more authorative.   
 
I have come to the conclusion that low health literacy unquestionably affects patient’s 
quality of healthcare. If a patient cannot understand their diagnosis, their medications, or their 
treatment and is too ashamed to ask it can seriously lessen their quality of healthcare. Not only 
does it affect the patient, it also affects the economy costing the U.S. $238 billion annually. 
There are enough elderly and illiterate patients struggling with understanding their health 
information that it has become a significant problem. Patients with low health literacy are much 
more likely to be nonadherent to their healthcare plans, have frequent hospital admissions, and 
be prone to potentially fatal mistakes due to their inability to obtain, process, and analyze basic 
health information.