Health information can be confusing for anyone. Clear health communication is an important part of a patient's ability to understand and act upon health information. This can include a patient's ability to follow instructions after a doctor's visit, to manage a chronic illness, or to take a medication properly. For health care practitioners, clear health communication guides which words are used, how directions are given, and what materials are presented when communicating with patients.
Health literacy is defined as the ability to read, understand, and act on health information. It involves more than a measurement of reading skills--it also relates to listening, speaking and conceptual knowledge. Low health literacy can affect any population segment, regardless of age, race, education or income, and cannot be detected by physical symptoms or examinations.
Health Literacy Statistics
According to the 2003 National Assessment of Adult Literacy (NAAL), almost 45% of the United States population (or 93 million Americans) have only basic or below basic literacy skills.
* Nearly half of the U.S. adult population (90 million people) have low functional health literacy (National Adult Literacy Survey (NALS) data)
* 11 million adults are non-literate in English (2003 National Assessment of Adult Literacy (NAAL) data)
* 7.8 million seniors can only perform the most simple and concrete literacy skills (Below Basic) (2003 National Assessment of Adult Literacy (NAAL) data)
A Serious Impact
As an emerging public health issue, low health literacy is often misunderstood as a condition that affects a specific portion of the population. In reality, its scope is broad and its impact severe. Although low health literacy can affect everyone regardless of background or educational level, studies on the issue show that limited literacy skills are a stronger predictor of an individual's health status than age, income, employment status, education level, and racial or ethnic group.
People with low functional health literacy:
* Are often less likely to comply with prescribed treatment and self-care regimens.
* Make more medication or treatment errors
* Fail to seek preventive care and are at higher (more than double) risk for hospitalization.
* Remain in the hospital nearly two days longer than adults with higher health literacy.
* Often require additional care that results in annual health care costs that are four times higher than for those with higher literacy skills.
* Lack the skills needed to negotiate the health care system
Why is Health Literacy Important to Me?
Chances are high that some of your patients are among the 90 million people in the United States whose health may be at risk because of difficulty in understanding and acting on health information. When identifying patients at risk for low health literacy, it is important to remember that 'you cannot tell by looking.' People with low health literacy skills have developed a number of clever and successful coping strategies that allow them to conceal their problem. Some patients bring along a friend or family member who can assist with reading. Patients may also watch the behavior of others in the same situation and copy their actions. Some ask for help from the medical staff, while others may ask for assistance from other patients.
Although it may be difficult to identify a patient with low health literacy skills, there are clues that a patient may need additional help. These include:
* Registration and other forms filled out incompletely or incorrectly.
* Written materials handed to a relative or other person accompanying the patient.
* 'I will read this at home.'
* 'I can't read this now; I forgot my glasses.'
* Aloofness or withdrawal during physician/ provider explanations.
* Frequently misses appointments, including appointments for specialty consultations or additional laboratory tests.
* Frequent errors in medications or self-care instructions, and consequently considered 'noncompliant.'
Helping Patients Succeed: A Solution to the Health Literacy Problem
By using clear health communication techniques, you can help your patients to better understand their condition and follow your instructions for better health outcomes.
Help patients remember your instructions with the 'Teach Back' Method.
* The 'Teach Back' Method is simply asking your patients to repeat in their own words what they need to do when they leave your office. This method allows you to check your patient's understanding of your medical instructions.
* You do not want your patients to view the Teach Back task as a test, but rather of how well you explained the concept. You can place the responsibility on yourself by using this suggested language:
* 'I want to be sure that I did a good job explaining your blood pressure medications, because this can be confusing. Can you tell me what changes we decided to make and how you will now take the medication?'
* If your patient is not able to repeat the information accurately, try to re-phrase the information, rather than just repeat it. Then, ask the patient to repeat the instructions again until you feel comfortable that the patient really understands the information.
What Else Can You Do To Increase Your Patients' Understanding?
Use visual aids and illustrations: Many people remember information better when it is presented to them visually. You can draw simple pictures or diagrams to help explain your instructions.
Beware of words with multiple meanings: Always clarify the meaning of words that can interpreted in more than one way. 'Stool,' 'gait' and 'dressing' are words that can have different meanings depending on how they are used in a sentence. When possible, try to use words that have only one meaning, or be sure to clarify the meaning of a confusing word.
Avoid acronyms and other new words: Acronyms such as 'CAT scan' and 'HDL' are common to you, but some of your patients may not understand them. Say or write the complete phrase the first time you use it, then explain the meaning. For example, you can explain that 'HDL' means 'the good cholesterol.'
Provide a health context for numbers and mathematical concepts: Health measurements, such as cholesterol or glucose levels, have little meaning to patients unless you put them into a context the patient can understand. Instead of just telling patients their numbers, give them additional information such as high and low parameters or a goal number. For example, 'Your cholesterol level is 305. A healthy cholesterol level would be less than 200, so we need to talk about how we can lower your number.'
Take a pause: Medical instructions can be confusing, so slow down and take pauses to give your patient time to digest the information and ask for clarification.
Be an Active Listener: Active listening means encouraging patients to talk and can be used to gather information. Allow your patients to tell their story or information they feel is necessary for their visit.
Address quizzical looks: You may notice that your patient sometimes may look confused, stare blankly, or may not seem to be paying attention when you are discussing medical instructions. These may be signs that the patient does not understand what you are explaining. Re-phrase your instructions by using simpler words and concepts, and draw pictures if appropriate. Remember to use the 'Teach Back' method to ensure that your patients understand and can communicate what they are going to do when they leave your office.
Create a welcoming and supportive environment: Patients are most comfortable in an office that feels private and encourages communication. From the registration desk to the exam room, patients should be encouraged to ask questions. Discussions with the patient, whether it be with you or the nurse, should not be held in front of other staff or patients but rather, covered during his or her private consultation time.
