low literacy

Communication

Skills

for the

Health Care

Professional

Concepts, Practice, and Evidence

Gwen van Servellen

CHAPTER 13

© 2009 Jones and Bartlett Publishers

Chapter 13
Communicating with Patients of Low Literacy

© 2009 Jones and Bartlett Publishers

Objectives

• The problem of low literacy in the United States
• Differences between literacy and functional health literacy
• Relationship of education and functional health literacy
• Barriers to health literacy
• Relationship of low health literacy and poor health outcomes

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Objectives Continued

• Populations at risk for health low health literacy
• Assessing level of health literacy in patients
• Ways providers can assess and enhance health literacy
• Importance of using “plain language”
• Dealing with shame related to low literacy
• Ways systems of care deter or promote health literacy

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Health Literacy as a Foundation for Patient Safety and Quality Care

• Health literacy involves both patient and providers ability to understand each other
• Must be viewed in the context of culture and health disparities

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Problem of Literacy in the U.S.

• Illiteracy as a national epidemic (Young, 2004)
• Health illiteracy, the hidden handicap (Glassby, 2002)
• Illiterate patients frequently feel ashamed to reveal their illiteracy and may not engage in dialogue

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Functional Health Literacy

• Refers to the skills and knowledge necessary to understand illness and treatment and to navigate the health care system
• Literate patients
• Empower patients to be active participants
• More likely to initiate and sustain important self-management behaviors
• Receive better quality health care

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Functional Health Literacy and Quality Care Outcomes

• Cumulative evidence that health literacy is associated with
• Better health status
• Better treatment adherence
• Lower levels of morbidity and mortality
• Lower use of hospitalization
• Better use of preventive health services
• Lower costs of health care services

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Healthy People 2010

• Health literacy includes ability to understand
• Instructions on prescription drug bottles
• Appointment slips
• Medical education brochures
• Medical directions and consent forms
• How to navigate complex health care systems

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Barriers to Health Literacy

• Individual level, e.g. education, health status
• Patient-provider factors, e.g. continuity of relationship, trust and satisfaction with the relationship, shared cultural understandings
• System related factors, e.g. number, length and quality of encounters, whether patient-centered care delivery system

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Elements of Systems More Likely to Promote Health Literacy

• Constructs reading materials using plain language with illustrations
• Tests and evaluates appropriateness of materials for many different groups
• Provider encounters exceed 6-10 minutes
• Advocacy for health literacy
• Providers skills in assessing
• Opportunities to conduct feedback loop
• Population-based literacy best-practice program

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Assessing Health Literacy

• REALM and REALM-R
• TOFLA and S-TOFLA
• SAHLSA-50
• NVS (Newest Vital Sign)

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Assessing Health Literacy (cont’d)

• Communication assessments
• Avoids asking for help; quiet and unassuming
• Reserves questions until leaving the provider
• Asks then withdraws the question
• Misses appointments
• Non-adherence to treatment plan
• Comes with companions to interpret
• Delays making decisions and asks for things in writing

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Improving Patient Health Literacy

• Develop a “gestalt” of the patient
• Assess health literacy
• Avoid shaming
• Comprehension may be even at 1st grade level; may not know how to read
• Use brief and simple language
• Slow the pace to the patient
• Deliver messages in context known and valued by patient

© 2009 Jones and Bartlett Publishers

Improving Patient Health Literacy (cont’d)

• Repeat materials
• Use meaningful visuals; draw pictures
• Use patient’s concepts of medical terms
• Tell stories to embellish points
• Use feedback loop, teach-back and close the loop

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Summary

Improving health care literacy requires first, communicating in the language of the patients we serve but then helping them adapt other means to describe their health and concerns. They need to understand us and us, them.

© 2009 Jones and Bartlett Publishers