The invisible barrier: literacy and its relationship with oral health. A report of a workgroup sponsored by the National Institute of Dental and Craniofacial Research, National Institute of Health, U.S. Public Health Service, Department of Health and Human Services.

Although oral health in the United States has improved significantly over time, preventable and treatable oral diseases remain common, especially among the poor and underserved. Limited literacy skills among adults are hypothesized to be one of many barriers to better oral health outcomes. Adults must be able to understand, interpret, and act on health information, whether it is communicated in spoken or in written form, to maintain their oral health and manage disease. While the body of health literacy research has grown in recent years, little is known about oral health literacy. Research is needed to build an understanding of oral health literacy and its impact on a variety of outcomes, including adoption of effective disease prevention regimens and actions, adherence to treatment regimens, effectiveness of caregivers and ultimately, improved oral health status. In addition, the effect of oral health literacy on the validity of clinical research such as response to surveys and adherence to research protocols is another area that is important to investigate. This paper defines oral health literacy and offers a framework for studying relationships between oral health literacy and other points of intervention for improving health outcomes. Findings of existing health literacy research are summarized, and a research plan for oral health literacy is proposed. A broad-based collaborative effort will be required to develop a detailed agenda for research, one that is aimed at reducing literacy barriers to oral health and ensuring that the information and insights emanating from new oral health research are more widely adopted.