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In addition, remember to document thoroughly findings from your health literacy assessment and confirmation of the patient’s understanding. Topics for discussion include the following:

  • Level of disease knowledge, including progression and complications.

  • Safety issues, such as whether the individual has a supportive living situation. Regarding safety, the care management team must address the hazards in the home, especially if the individual is suicidal or psychotic. An individual may have low energy early in depression, but once they are feeling better during treatment, they still may have suicidal ideation. This may be one of the most critical times for assessment and intervention if necessary.

  • Knowledge and ability to obtain follow-up care with mental health providers.

  • Reasons for a balanced diet and exercise, which may increase overall well-being. Exercise increases endorphins that may also act as an antidepressant. Make sure the individual understands that if any changes in his/her lifestyle occur, he/she should communicate this to his/her mental health providers.

  • Level of medication knowledge.

Remember that individuals with low health literacy, as outlined by the Partnership for Clear Health Communication,68 may exhibit the behaviors listed below. The understanding of the symptoms and treatment of depression that individuals at risk for low health literacy have may vary.

  • They are less likely to comply with prescribed treatment and self-care


  • They make more medication or treatment errors.68

  • They fail to seek preventive care.68

  • They are at higher risk for hospitalization.68

  • They remain in the hospital nearly two days longer.68

  • They lack the skills needed to navigate the healthcare system.68

According to the National Adult Literacy Survey half of the adult population in the United States has limited or low literacy skills. Individuals with inadequate health literacy were more than twice as likely to report depressive symptoms.69,70 Therefore, it may a good idea to assess the literacy skills of individuals who are depressed and to recommend that patients with both depression and limited literacy receive specific attention to determine the level of comprehension.71

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