When Angelica Alvidrez took her daughter to the emergency room for a high fever, she was surprised she got stuck with the bill for medical tests.

"I didn't know I was supposed to call my insurance first," she said.

Danielle Gehrt took one look at a hospital admission form and knew she wouldn't understand it.

"They need to shorten it up and use simple words," she said.

The Dane County women are among an estimated 36 percent of Americans who struggle with health literacy - the ability to understand and act on medical information.

Some, like Alvidrez, are learning English as a second language. Others, like Gehrt, are native speakers who wrestle with complicated words.

The issue, which has gained attention nationally in recent years, will be discussed Tuesday and Wednesday at a Health Literacy Summit at the Alliant Energy Center.

\ Many efforts

The conference is sponsored by Wisconsin Literacy, a nonprofit organization that supports 58 literacy programs around the state. The event is one of several Madison-based efforts drawing attention to health literacy and trying to improve conditions for patients.

At St. Mary's Hospital, adult basic education students from Madison's Omega School recently joined hospital staff in evaluating documents and directional signs.

The Literacy Network, which offers tutoring in Madison, has started classes on health literacy.

Focus groups run by Wisconsin Literacy two years ago in Madison, Oshkosh and Racine found that many participants, from literacy programs, didn't understand medication doses or side effects. Some said they were reluctant to tell doctors or nurses when they were confused.

A nurse involved in the focus groups reported that a patient with no apparent reading problems signed a consent form for a hysterectomy and received the surgery to remove her uterus; then the woman asked when she could try to become pregnant.

Wisconsin Literacy is developing a health literacy curriculum for student nurses at Western Technical College and nurses at Franciscan Skemp Mayo Health System, both in La Crosse, so nurses can better understand the challenges patients face.

"We want to infuse it into their DNA," Michele Erikson, executive director of Wisconsin Literacy, said of the nurses.

Dr. Paul Smith, a UW-Madison family medicine physician, said he was surprised to learn after 15 years in practice that some patients didn't understand instructions for taking medications or the various forms they have to sign.

"It's no surprise many people aren't doing what we ask them to do because they don't understand it," he said.

Low health literacy costs up to $236 billion a year nationally, including $7.6 billion in Wisconsin and $466 million in Dane County, according to John Vernon, a health economist at the University of Connecticut.

\ St. Mary's program

Smith said he hopes a pilot program he developed at St. Mary's might become a national model for hospitals to improve health literacy.

He arranged for students at Omega School to serve as consultants at the hospital. They evaluated three documents: an admission form, a pain management guide and a guide to legal and ethical decisions. They also tried to find three places in the hospital: medical imaging, the birth suites and the cafeteria.

A few hospital staff members did the same tasks, separately from the students.

The documents were confusing, said Gehrt, one of the students. The admission form, which contains jargon-filled terms such as "allied health care providers," is crowded onto two pages in small type, she said.

"They should add pictures to make it easier to read," said the 21-year-old from Brooklyn. She is studying for her general education development, or GED, diploma.

Anthony Lavigne, 18, of Madison, who is also preparing for his GED, said he and the other students ended up at Dean Health System's medical imaging unit instead of St. Mary's unit because signs were vague. Dean, a physician group, and St. Mary's both have services on the hospital campus.

The hospital staff group made the same mistake. Both groups also noted confusion over signs for the birth suites, where women give birth; the family care suites, for post-delivery recovery; and the family care center, which covers all birthing-related services, including pre-delivery care.

Dr. Frank Byrne, St. Mary's president, said he welcomed the input and would consider changes to make it easier for patients to understand documents and navigate the hospital.

"This gives us some good ideas on how we can make some improvements," he said.

\ Asking questions

For Fermin Gaytan Flores, any effort to make health information easier to understand would help.

The 27-year-old from Madison said he was confused when he recently got a report in the mail with results from blood tests performed during a physical exam.

A chart with numbers and abbreviations showed that he had some levels labeled "abnormal," but no further explanation was provided. He said he was told that he won't be able to learn more about the results until his next doctor appointment.

"It's very difficult to understand," he said. "I worry."

Alvidrez, 32, of Madison, takes classes at the Literacy Network, including a recent unit on health literacy. She said she realizes that asking questions is the best way to understand information about her health and the health of her three young children.

But asking questions can be challenge, she said. Her doctor at the Wingra Family Medical Center speaks Spanish, but Alvidrez usually deals with English-speaking aides over the phone.

"It's hard for them to have time for me," she said. "They're always so busy."

\ ASK ME 3

Health literacy experts encourage patients to ask doctors, nurses and pharmacists three questions to make sure they understand health information:

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this?

To learn more, visit www.npsf.org/askme3.