The document discusses health literacy and effective patient-physician communication strategies, noting that limited health literacy adversely impacts patient health outcomes and that using clear communication techniques such as plain language, teach back methods, and soliciting questions can help address this issue and improve patient understanding. It also provides statistics showing nearly half of U.S. adults have below basic or basic health literacy skills.

1. Health literacy:
Effective patient-physician
communication strategies
Dr. Jennifer Adams

2. Thanks to
 Dr. Jenny Lin
 Dr. Michael.Paasche-Orlow

3. Learning Objectives
1. Define health literacy and review national statistics
2. List at least two ways in which low health literacy
adversely impacts health
3. Know the core components of clear health
communication and be able to use these
4. Describe at least two communication strategies to
combat low health literacy
5. Explore low literacy patient materials for use

4. Quiz
1. Approximately what percentage of the
US population reads at or below a
basic (8th) grade reading level?
1. 15%
2. 25%
3. 35%
4. 45%
5. 55%

5. Health Literacy Is…
“The degree to which individuals have the capacity to
obtain, process, and understand basic health information
and services needed to make appropriate health
decisions.”
Healthy People 2010

6. What patients need
health literacy for
Ability to perform essential health care tasks:
– Understand appointment slips
– Follow instructions on medication labels
– Obtain information about an illness
– Participate in discussions of informed consent
– Enroll in health insurance plan

7. Health Literacy in America
National Assessment of Adult Literacy (NAAL)
– National sample survey, 2003, N~20,000
– Prose, document, and quantitative literacy
Prose Document Quantitative
– Provided first national assessment of health literacy
– Levels: below basic, basic, intermediate, or proficient
From http://nces.ed.gov/naal/

8. Health Literacy in America:
Results from the NAAL
100% Proficient: Define medical term from complex document,
12%
90% Calculate share of employee’s health insurance costs
80%
70%
Intermediate: Determine healthy weight from BMI
60% 53%
chart, Interpret prescription and over-the-counter drug
50% labels
40%
30%
22% Basic: Understand simple patient education handout
20%
10% Below Basic: Circle date on appointment slip,
14%
Understand simple pamphlet about pre-test instructions
0%
Kutner et al. National Assessment of Adult Literacy, 2006

9. Why Is Health Literacy
Important in Patient Care?
 Most patient instructions are written
 Verbal instructions
– Often complex
– Delivered rapidly
– Easy to forget in stressful situation
 Increasingly complex health system
– More medications
– More tests and procedures
– Greater self-care requirements
– Participatory/informed decision-making

10. Low Literacy Affects
Patients’ Understanding
Percent
Correct
 Identify next appointment 73%
 Take medicine every 6 hours 52%
 Take medicine on empty stomach 46%
 Interpret blood sugar value 32%
 Upper GI instructions (4th grade) 24%
 Medicaid Rights (10th grade) 0%
Gazmararian, JAMA 1999

11. Literacy and Health Outcomes
Health Outcomes/Health Services Behaviors Only
 General health status  Substance abuse*
 Hospitalization  Breastfeeding
 Emergency department use  Behavioral problems
 Prostate cancer stage  Adherence to medication*
 Depression  Smoking*
 Diabetes control
Knowledge Only
 HIV control
 Birth control knowledge
 Mammography
 Cervical cancer screening
 Pap smear
 Emergency department
 Pneumococcal immunization
instructions
 Influenza immunization
 Asthma knowledge
 STD screening
 Hypertension knowledge
 Cost
Mortality

12. All-Cause Mortality by
Literacy
10.6% mortality
vs.
19.7% mortality
(p<.001)
Sudore, JGIM 2006; ; 21: 806-12

13. Low Literacy and
Mortality
 Limited literacy
independently
predicts all-cause
and cardiovas-
cular deaths in
the elderly
(39.4% vs
18.9% with HR
1.52, CI 1.26-
1.83)
Baker et al, Arch Int Med 2007;167: 1503-9

14. Patient Testimonials
Video

15. Strategies to Improve
Communication
 Strategies recommended for ALL patients
– Universal Precautions
 Explain things clearly in plain language
 Use a “teach back” or “show me” technique
to check understanding
 Effectively solicit questions
 Focus on key messages and repeat
 Use patient-friendly educational materials to
enhance interaction

16. Explain Things Clearly
in Plain Language
 Slow down the pace of your speech
 Use plain, non-medical language
– “Pain killer” instead of “analgesic”
– Use patient’s own terms
 Define new terms
 Be specific
– What does taking medicine “on an empty stomach”
really mean?
 Avoid concept words
– “Hamburger” instead of “red meat”
 Draw pictures and use analogies
– “Arthritis is like a creaky hinge on a door.”

17. Using Plain Language:
What could we say instead of…
 Angina  Chest pain
 Atherosclerosis  Clogged blood vessels
 Benign  Not cancer
 Shot, vaccine
 Immunization   High blood pressure
 Hypertension
 Normal test
 “Negative” test
 Take 1 pill in the
 Take one tablet morning and 1 pill in
twice daily for the evening for 7
seven days days

18. Teach Back Scripts
 “I want to make sure I explained everything
clearly. If you were talking to a friend, what
would you tell her we talked about today?”
 “Let’s review the next steps. Can you tell me
the 3 things that you need to do before the
next visit?”
 “Show me how you would...”
 “How would you know if your blood sugar
was low?”

19. Effectively solicit
questions
 Don’t say:
– Do you have any questions?
– Any questions?
 Instead ask:
What questions do you have?

20. What did we learn?
 Limited Health literacy is a barrier to
optimal health
 All members of the health care team
must work together to help patients
with limited health literacy
 Using Clear communications skills will
help provide optimal care for patients
with limited literacy skills