Addressing Low Health Literacy
Nearly half of all American adults (90 million people) have difficulty understanding and acting upon health information. This is a key finding from the Institute of Medicine (IOM) report entitled, "Health Literacy: A Prescription to End Confusion". The IOM contends that, if patients cannot comprehend needed health information, attempts to improve the quality of care and reduce health care costs and disparities may not succeed.
Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions about their health. This problem is often associated with low literacy, but even well-educated people with strong reading and writing skills may have trouble comprehending a medical form or doctor's instructions about a drug or procedure.
The first step is to identify the problem. Patients/parents with low health literacy look like any other patients/parents and they are usually pretty good at pretending that they understand. Behaviors that may give them away include the following: incompletely or inaccurately completed patient registration forms; frequently missed appointments; non-adherence with prescribed medication regimen; and not following through on orders for laboratory tests, imaging tests, or referrals to consultants. It's easy to label these patients/parents as "troublemakers" or "noncompliant;' but be careful; these could be folks who really want to do what's right, but don't understand how.
Slow down. Speak slowly and spend just a little more time with patients/parents. Remain calm and unrushed, no matter how hectic the day may be outside that room. Focus on the patient and the parent and the time you are spending with them. Sit rather than stand. Listen rather than speak.
Use plain, non-medical language. Explain things to patients/parents using "living-room language"; not medical jargon.
Show or draw pictures. Visual images can improve the patient/parent's understanding and recall of ideas. Use brochures with pictures or diagrams. Public health clinics often have educational brochures intended for those with low literacy levels.
Limit the amount of information provided and repeat it before moving on. Use orienting statements: "First I will ask you some questions and then I will listen to your heart." Watch for signs of "tracking", and deliver information in small, digestible bites. Repeat as necessary and then add more information.
Use the teach-back or show-me technique. Confirm that patients/parents understand by asking them to repeat back the instructions; or, ask them, "how would you explain this to your spouse or a friend?" If the patient/parent does not explain it correctly, assume that you have not provided adequate teaching. Try again using another approach.
Create a shame-free environment. Never show any frustration that they didn't catch on the first time. Avoid asking, "Do you understand?" Patients/parents tend to say yes because they don't want to appear stupid. Instead say, "Do you have any concerns that I haven't addressed?" Encourage patients/parents to ask questions.
Build in safeguards. Make it clear to patients/parents that if they get home and cannot remember exactly what they are to do, it is okay to call the office for help.