How to communicate effectively with patients. Organisation-wide steps to patient involvement in their health. Perils of poor health literacy, or poor communication with patient. In-patient, discharge information in particular.

1. The Good Patient Meeting
Library Elevenses
Tuesday 15th August 2017

2. Health Literacy
• Health services communicate clearly and take
account of possible health literacy and
numeracy needs.
• People understand health information
correctly and can make an informed decision.
https://www.nala.ie/sites/default/files/nala_002_health_sheet_hr.pdf

3. • Smart people can
have poor health
literacy skills
• If patients don’t
understand their
care instructions,
that’s a failure of the
health service and a
risk to the patient

4. Consequences of poor health literacy
• Safety: Cajita, M.I., Cajita, T.R. and Han, H.R., 2016. Health literacy and heart failure: a systematic
review. The Journal of cardiovascular nursing, 31(2), p.121; “43% of English working-age adults will
struggle to understand instructions to calculate a childhood paracetamol dose”
• Health inequality: Bostock S, Steptoe A. Association between low functional health literacy and
mortality in older adults: longitudinal cohort study. BMJ 2012;344(1602) and Joshi, Chandni et al.
“Does Health Literacy Affect Patients’ Receipt of Preventative Primary Care? A Multilevel
Analysis.” BMC Family Practice 15 (2014): 171. PMC. Web. 12 Jan. 2017.
• Use of Healthcare Services: Baker, D.W., Parker, R.M., Williams, M.V. and Clark, W.S., 1998. Health
Literacy and the Risk of Hospital Admission. J GEN INTERN MED, 13, pp.791-798 and Berkman,
N.D., Sheridan, S.L., Donahue, K.E., Halpern, D.J. and Crotty, K., 2011. Low Health Literacy and
Health Outcomes: An Updated Systematic Review. Ann Intern Med, 155, pp.97-107. “Low health
literacy was consistently associated with more hospitalizations; greater use of emergency care…..”
• Other documents: World Health Organization (WHO), 2016. Health literacy. The solid facts ,
Comparative report on health literacy in eight EU member states. The European Health Literacy
Project 2009–2012. Maastricht, HLS-EU Consortium, 2012 (http://www.health-literacy.eu).
• Policy or Legislation: National Guidelines on Accessible Health and Social Care Services: Part One
and National Consent Policy. (See: Perrenoud, B., Velonaki, V.S., Bodenmann, P. and Ramelet, A.S.,
2015. The effectiveness of health literacy interventions on the informed consent process of health
care users: a systematic review protocol. JBI database of systematic reviews and implementation
reports, 13(10), pp.82-94.)

5. What
medication
have they
been given?
Is English
their first
language?
Are there
distractions
during the
patient chat?
What
news have
they been
given?
How much
time have you
got to talk with
them?
Are they
aware of the
importance
of the
instructions?
What tools
do you have
to explain
their
condition?
Have they
a friend
or
relative
with
them?

6. “Ask me three”
What’s my main problem?
What do I need to do (or not do)?
Why is it important that I do/don’t do this?

7. Useful techniques
Teach-back: ask patients to repeat in their
own words
Chunk and check
Simple language
Use pictures, diagrams
Encourage questions: flip roles
Joint problem-solving
Do they need help with form-filling?
Entitlements?

8. Common patient misconceptions
• “tsp”: tablespoon
• “Your results are positive” (patient: Great!)
• “Bone is fractured” (patient: bone is a bit
cracked, but TG not broken)
• “I understood, but there was no chance I’d
have been able to do that”
• “All vaccines give you a mild dose of the
condition they are supposed to cure”
• Treatment drug or prevention drug?

9. Health Literacy in a Hospital setting
HIQA/NALA (2015) Video Communicating in
plain english (6min 30sec)
HIQA/NALA (2015) Guidance booklet (48p):
“Guidance for providers of health and social care
services: communicating in plain English”

10. NALA Quality Standards for Hospitals

13. The AHRQ “Universal Precautions”
toolkit
Focuses on 4 key areas:
• Verbal communication
• Written communication
• Self-management and empowerment
• Supportive systems (SIGNAGE!)

14. HEAL “Health Education & Libraries”
“To build health literacy in Ireland by
providing guidance to the general
public on finding and assessing reliable
online health information”

15. A partnership between SVHG Health Librarians, Dublin Public
Librarians, & UCD School of Nursing, Midwifery and Health
Systems
Public Librarians
(Dublin only for pilot):
• Local Gov’t support
(LGMA)
• Relationship with
Public
• Host website
• Previous
experience
Health Librarians:
• Information Quality
Standards
• Health Professionals
• Electronic Health
Record
• Patients
UCD School of Nursing
Midwifery & Health
Systems:
• Community
networks
• Research funding
• Ethics approval
• Project experience
Mind Reading

16. Survey through
Dublin City Libraries
• Ran for two weeks
• Online or in print
• Available through
English or Irish
• Over 1300 responses

17. Health in the news
"Acupuncture may help
elderly people retain their
memory, research suggests,"
the Daily Mail reports.
Binge watching TV can actually
kill you, study finds. The
Independent, July 26 2016Two chocolate bars a day
can SLASH the risk of heart
disease and stroke. Daily
Mirror, June 16 2015
Revealed: How to lose
weight - drink plenty of red
wine. The Daily Telegraph,
June 21 2015
Daily dose of housework
could cut risk of breast
cancer (Daily Mail Reporter,
1 October 2009)

18. From: The Nib
https://thenib
.com/

19. Interested?
o Send on samples of current leaflets
o Champion one or more of the “18 Quality
Standards” from NALA
o Proof-read content we plan to use for HEAL
o Provide feedback from practice – what works/
doesn’t work
o Give a talk on a health/lifestyle topic
o Do a short (2/3 minute) video piece on a topic
o Test a consumer information product

20. • Abrams, M.A., Kurtz-Rossi, S., Riffenburgh, A. and Savage,
B.A., (2014) Building health literate organizations: A
guidebook to achieving organizational change. Iowa:
UnityPoint Health.
• Brach, C., Keller, D., Hernandez, L.M., Baur, C., Dreyer, B.,
Schyve, P., Lemerise, A.J. and Schillinger, D., (2012) Ten
attributes of health literate health care organizations (pp. 1-
26). Washington, DC: Institute of Medicine of the National
Academies.
• Trezona, A (2017) Development of the organisational health
literacy responsiveness (Org-HLR) framework in collaboration
with health and social services professionals. BMC Health
Services Research, 17; pp 513
Additional reading

21. Thank you
Anne.madden@ucd.ie
Library & Information Services
St. Vincent’s University Hospital