![]() regional dialects or ethnic speech variations) may have very high overall literacy A patient who speaks non-standard English (i.e.A patient from “mainstream” American culture may have good verbal skills but may not be able to read.A provider’s ability to identify low health literacy begins with being aware of assumptions we may find ourselves making about people’s literacy. Providers routinely overestimate the ability of individual patients to participate in healthcare conversations and follow instructions. This latter group may be especially at risk of having their low health literacy go unrecognized. Cultural barriers to understanding western medicine, limited English proficiency, and low health literacy make up the “triple threat.” Low health literacy, though often associated with culture and language barriers, is also found in patients who are proficient in English and who share the mainstream American culture. In a report by the Joint Commission in 2007, the “triple threat” to health communication was identified as a leading cause in poor health outcomes in Americans.
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