In order to advance patient safety, it is critical to optimize tools to help address health literacy challenges.
By Tejal K. Gandhi, MD, MPH, CPPS
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Earlier this year, the National Patient Safety Foundation’s Lucian Leape Institute issued a report about how patient and family engagement is critical for patient safety, citing health literacy problems as one of the barriers to effective patient partnerships. With Health Literacy Month in progress, there is no better time to learn more about this topic and to work to improve communication.
The Institute of Medicine defines health literacy as “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions” (Nielsen-Bohlman 2004). That involves more than just the ability to understand word meanings. It requires listening skills, communicating thoughts, facility with numbers, and judgment. By some estimates, only 12% of English-speaking adults in the United States are proficient in these skills (National Action Plan 2010).
Patients with poor health literacy skills, “receive less preventive care, have less knowledge about chronic conditions, perform more poorly at self-care, use health care services at a higher rate, and have worse outcomes on a variety of measures than do patients with better literacy.” (NPSF Leape Institute 2014; Johnson et al. 2008).
Clinicians and consumers alike need help in the form of training and tools that can facilitate communication—and ultimately lead to more meaningful and productive engagement and partnership. Health professionals who provide information and services need training on clear communication principles and skills to ensure that patients fully understand their health status and care plans.
The US Department of Health and Human Services, the CDC, The Joint Commission, and others (Weiss 2007; Roter 2011) have recommended relatively simple tactics that health professionals can use to improve communication with patients:
- Slow down your speech
- Limit, and repeat, information at every visit
- Avoid medical jargon (See Words to Watch)
- Use illustrations to explain important concepts
- Use easy-to-read written materials
- Make visits interactive by encouraging questions
- Use “teach-back” to gauge comprehension
To really step up on health literacy, organizations should test their patient information and education materials with a sampling of their audience—patients—to gauge comprehension and ease of use (HRSA 2010).
Another thing that health professionals can do right now is to explore some of the resources that are currently available to help.
- The Centers for Disease Control and Prevention has a vast array of resources available, including background research, help in developing materials, and information about activities at the state level.
- The Health Literacy Universal Precautions Toolkit, provided by the Agency for Healthcare Research and Quality, offers guidelines for all levels of staff.
- The National Network of Libraries of Medicine is a good source of background research, bibliographies, and resources.
- The US Department of Health and Human Services Office of Disease Prevention and Health Promotion offers the online Quick Guide to Health Literacy, a good starting point for the basics of how to improve the usability of the information you are giving to patients.
- Medline Plus, produced by the National Library of Medicine, offers materials for both patients and clinicians. It has a health literacy section, and much of the content is available in Spanish as well as English.
- Health Literacy San Diego offers information about tests that you can use to measure the reading level of your content.
- Last but not least, the National Patient Safety Foundation offers the Ask Me 3 program, which includes materials designed to encourage patients to ask questions and be more involved in their care, particularly when they don’t immediately understand something.
What are you doing to improve health literacy in your organization? Comment on this post below.
CDC (Centers for Disease Control and Prevention). Health Literacy—A Public Health Priority. In: Health Literacy for Public Health Professionals. http://www.cdc.gov/healthliteracy/training/page215.html
DeWalt DA et al. 2010. Health Literacy Universal Precautions Toolkit. (Prepared by North Carolina Network Consortium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF) Rockville, MD. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthliteracytoolkit.pdf
The Joint Commission. 2007. "What Did the Doctor Say?" Improving Health Literacy to Protect Patient Safety. A Health Care at the Crossroads Report. http://www.jointcommission.org/What_Did_the_Doctor_Say/
HRSA (U.S. Department of Health and Human Services: Office of Disease Prevention and Health Promotion. 2010. National Action Plan to Improve Health Literacy. Washington, DC. http://www.health.gov/communication/HLActionPlan/pdf/Health_Literacy_Action_Plan.pdf
HRSA (U.S. Department of Health and Human Services, Health Resources and Services Administration). Effective Health Care Communications Course. http://www.hrsa.gov/publichealth/healthliteracy/
Johnson B, et al. 2008. Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System. Bethesda, MD: Institute for Patient- and Family-Centered Care.
National Patient Safety Foundation Lucian Leape Institute. 2014. Safety Is Personal: Partnering with Patients and Families for the Safest Care. Boston, MA: National Patient Safety Foundation. http://c.ymcdn.com/sites/www.npsf.org/resource/resmgr/LLI/Safety_Is_Personal.pdf
Nielsen-Bohlman L, Panzer AM, Hamlin B, Kindig DA, Eds. (2004). Health Literacy: A Prescription to End Confusion. Institute of Medicine. Washington, DC: National Academies Press.
Roter D. 2011. Oral literacy demand of health care communication: challenges and solutions. Nursing Outlook. 59(2):79–84. http://www.ncbi.nlm.nih.gov/pubmed/21402203
Weiss B. 2007. Health Literacy and Patient Safety: Help Patients Understand: A Manual for Clinicians. Chicago: AMA Foundation. http://www.ama-assn.org/resources/doc/ama-foundation/healthlitclinicians.pdf