A woman recently came into an urgent care clinic because the antibiotics did not seem to be helping her child's ear infection. After some questioning, it was discovered that the oral antibiotic had been instilled in the painful ear. In another instance, the patient did not know to remove the wrapper from a suppository before inserting it. Another patient asked if a year was too long to wait for her MRI results and she was unsure if the flares in her spinal cord were good or bad. These are all examples of outcomes related to low health literacy. Health literacy is defined as 'the ability of patients to obtain, process, and understand the basic information and services needed to make appropriate decisions regarding their health' (Joint Commission, 2008).
According to Clancy (2008), almost 90 million Americans have basic or below-basic health literacy skills. Low health literacy is more likely to occur in individuals with limited English skills and education, ethnic and cultural minorities, those who are poor, and adults older than 65 (Institute of Medicine, 2004). Individuals with low health literacy are at greater risk for hospitalizations, are more likely to report poorer health in general, and are more likely to have misinterpretations about their treatments (Pawlak, 2005). In addition, low health literacy may contribute to increased medication errors and increased health care costs (Partnership for Clear Health Communication [PCHC], 2008a).
Literacy Tools
The Academy of Medical-Surgical Nurses has had a position statement related to health literacy for some time to assist medical-surgical nurses in various practice areas. Health literacy assessment tools, such as the Wide Range Achievement Test Revised (WRATR), Test of Functional Health Literacy in Adults (TOFHLA), and Rapid Estimate of Adult Literacy in Medicine (REALM), are available to help identify patients with low health literacy but have some limitations in clinical practice (Pawlak, 2005). A tool that is easy to use and takes approximately 3 minutes to administer by health care providers is the Newest Vital Sign (Pfizer, 2008). The screening tool uses a nutrition label from a container of ice cream to assess health literacy through a series of questions. Responding to the questions requires skills (applying numbers, words, and forms) that are necessary to understanding health care directions. The screening tool, which is available in English and Spanish, was validated against the TOFHLA and is available without cost to health care providers (Pfizer, 2008).
Medical-surgical nurses can be instrumental in implementing strategies to address low health literacy. Readily available patient education tools include the Speak Up[TM] tools from the Joint Commission (2008). These tools are designed to improve patient safety by helping patients with their health care experiences. The Joint Commission's Speak Up[TM] tools are available as free downloads or are available in brochure formats. These tools are not copyrighted and can be used as needed. Medication safety, infection control, medical tests, and pain management are some of the topics of the brochures (Joint Commission, 2008).
Medline Plus provides 'Easy to Read' health materials about numerous topics, such as diagnostic laparoscopy, general anesthesia, angina, asthma, and neurosurgery (National Library and National Institutes of Health, 2008). Some of the topics have accompanying interactive tutorials (available in English and Spanish) which can be viewed by patients in the health care setting or at home.
Another helpful resource is 'Ask Me 3' from the PCHC (2008b). Brochures are available for download in English, Spanish, Chinese, French, Russian, and Arabic. The 'Ask Me 3' method encourages patients to ask their health care three questions: 'What is my main problem? What do I need to do? Why is it important for me to do this?' (PCHC, 2008b). In addition to the use of the three questions, other practical suggestions are provided which help promote increased understanding of health care information. Strategies include providing an environment conducive to teaching and learning, avoiding the use of medical jargon, being seated rather than standing over the patient, using visual aides to teach patients, and using a 'teach back' to evaluate the patient's learning (PCHC, 2008b). Medical-surgical nurses are familiar with using a return demonstration method of evaluating the effectiveness of patient teaching.
Increasing Awareness
Recommendations for improving health literacy are complex. Increasing awareness of the extent of the health literacy issue in the United States is considered a key recommendation (U.S. Department of Health and Human Services [HHS], 2003). October is health literacy month and is an appropriate time to bring the issue to the forefront on an annual basis. The HHS (2003) recommends:
* Better communication skills of health care professionals.
* Partnering with adult education providers to improve health literacy skills.
* Increased access to health education information.
* Simplified, as well as, culturally and linguistically appropriate health education.
* Increased health literacy research and evidence-based practices.
Medical-surgical nurses can be instrumental in implementing these recommendations within their practice settings with the overall goal of improving health literacy of the public.
References
Clancy, C.M. (2008). What's your health literacy score? ARQ: Navigating the healthcare system. Retrieved September 9, 2008 from http://www.ahrq.gov/ CONSUMER/cc/cc052008.htm
Institute of Medicine of the National Academies. (2004). Health literacy: A prescription to end confusion. Washington, DC: National Academies Press.
Joint Commission. (2008). Health literacy and patient safety. Retrieved September 9, 2008 from http://www.ccforpatient safety.org/30889/
Partnership for Clear Health Communication (PCHC). (2008a). What is health literacy? Retrieved September 9, 2008 from http://www.npsf.org/pchc/health-literacy.php
Partnership for Clear Health Communication (PCHC). (2008b). Ask me 3. Retrieved September 9, 2008 from http://www. npsf.org/askme3/PCHC/
Pawlak, R. (2005). Economic considerations of health literacy. Nursing Economic$, 23(4), 173-180.
Pfizer. (2008). The newest vital sign: A new health literacy assessment tool for health care providers. Retrieved September 9, 2008 from http://www.pfizer healthliteracy.com/public-policy-researchers/newest-vital-sign.html
U.S. Department of Health and Human Services. (2003). Communicating health: Priorities and strategies for progress. Retrieved September 9, 2008 from http://odphp.osophs.dhhs.gov/projects/ healthcomm/objective2.htm
U.S. National Library and National Institutes of Health. (2008). Medline plus: Easy to read. Retrieved September 9, 2008 from http://www.nlm.nih.gov/medlineplus/easytoread/easytoread_a.html
Kathleen Reeves, MSN, RN, CNS, CMSRN President, AMSN
