AFACCT 2021 Conference

1. Teaching Health Literacy
Why it’s Important and HowYou Can Do It
Sonia Galvan, MS, RN, CNE
Dominique Gelmann, MS 4

2. Objectives
•• Discuss the importance of health literacy teaching at the
community college level
•• Explain priority health literacy best practices for health care
providers
•• Compare strategies for teaching health literacy at the
community college level

3. What is Health Literacy?
•Definition: “the degree to which individuals have the
capacity to obtain, process, and understand basic health
information and services needed to make appropriate
health decisions.”
U.S. Department of Health & Human Services, 2020

4. Why Health Literacy?
• Only 12% of U.S. citizens have levels of health literacy that are
considered proficient
• Health literacy levels directly affect patient outcomes:
• hospitalizations, preventative care access through screenings
and immunization, medication use, morbidity, and mortality
• Serves as a social determinant of health and moderates other
determinants

5. Background
• The first 10 years of addressing health literacy in the helping
professions focused on measuring patients' health literacy levels
and trying to change these.
• Shifting direction, Healthy People 2030’s definition of health
literacy includes organizational health literacy, which is the
degree to which society and/or organizations make health
information understandable (HHS, 2020).

6. Addressing Health Literacy—a Professional
Responsibility
•It is the providers' responsibility across the health
professions (Allied health, physical education) to
address health literacy through best practices in
dealing with patients
•Learning these skills in the educational pipeline is
CRUCIAL

7. Current State of Health LiteracyTeaching
• Integrative review of health literacy teaching across 7 professions
conducted this summer as part of UMB/UMCP MPower Coalition
summer project
• Findings:
• Inconsistent integration and evaluation of health literacy
teaching
• Need for more HL teaching to occur in the clinical setting
• Opportunities to integrate HL teaching into simulation and
interprofessional education

8. Why the Community College?
•Community college professional graduates have
extensive contact with patients
•In many degrees, the bulk of clinical education for
the entire undergraduate degree can be provided
through the community college system

9. Priority Health Literacy Practices
•Using teach-back communication
•Using plain language and avoiding jargon
•Open-ended questions
•Limiting education to 1-3 'take-home' points with clients
•Using an intepreter with patients who have limited
English proficiency (LEP)
•"Universal precautions"

10. Types of Health Literacy Education
•How often: Stand-alone, episodic, integrated
•Setting: Didactic, Clinical, Simulation

11. Case Study: A Health Literacy Module
• Virtual clinical module fall 2020, 2nd semester of ADN nursing program
• Objectives:
• Discuss how health literacy affects a patient’s quality of care
• Identify at least three factors that influence a patient’s health literacy
• Analyze factors that affect health communication
• Identify at least one tool or resource to assess a patient’s health literacy level and
language assistance needs
• Describe at least one method of communication that will improve understanding in
patients with limited health literacy

12. Part 1: Pre-Work
• Recorded pre-conference with instructions
• Students began by watching an AMA health literacy video
• They then completed:
• CDC certification “Health Literacy for Public Health
Professionals”.
• Certification through Maryland Dept. Of Health “Effective
Communication For HealthcareTeams: Addressing Health
Literacy, Limited English Proficiency and Cultural
Differences”

13. Part 2: Discussion Board Assignment
• Based on the pre-work, students answered the following questions, which were
graded for completeness and accuracy using a rubric
• What is the problem with asking a patient “Do you understand?”
• How should you ask a patient if they have any questions?
• Define universal precautions in relation to health literacy and explain why they are
necessary
• Give an example of jargon you have personally heard used in your time in practice/clinical
experience (or at your own or a family member’s interaction with health care
personnel) and explain how a patient might misinterpret it.
• Describe at least one example of how health literacy, cultural competence and limited
English proficiency each affect health communication
• Describe at least one method of communication that will improve understanding in patients
with limited health literacy

14. Part 3:Virtual Synchronous Clinical
•Powerpoint Presentation with Dominique as
interprofessional guest lecturer
•Application made locally—Baltimore metropolitan
area and Harford County statistics were shared
with students
•Interactive, case studies and plain language
exercises were presented

15. Interactive Example: Jargon
 Annually
 Arthritis
 Cardiovascular
 Dermatologist
 Diabetes
 Hypertension
 Orally
 Contraception
Once a year/every year
Pain in joints
Having to do with the heart
Skin doctor
Too much sugar in the blood
High blood pressure
Take by mouth/swallow
Birth control
8

16. Interactive Example: Case Study--Frank
• Frank tells you, “I understand that I
have diabetes now, I have to take
these medications for my blood
sugar three times in the day. I have
to check my blood sugar too. If my
blood sugar is good I may not have
to take the medications.”
• What follow-up questions would
you ask?

17. Interactive Example: Plain Language Materials
• Hypertension is a silent killer. It can cause end organ
damage in many systems—cardiovascular, renal,
neurovascular, and visual. To prevent an exacerbation of
hypertension, it is important that the patient adheres exactly
to a medication regimen for hypertension control, and that
sodium, saturated fat, and processed foods are limited in the
diet.

18. Helpful Links
• CDC certification link: https://www.train.org/cdctrain/course/1078759/
• Cultural Competency and
Linguistic Link https://www.train.org/maryland/training_plan/3985
• Health Literacy for Clinicians toolkit with ppt and
script: https://www.cancerpatienteducation.org/CPEN/Professional_Resour
ces/Health_Literacy_Toolkit.aspx?WebsiteKey=d0520575-8dcd-41dc-926d-
bae52e9ef291&hkey=04e41660-5867-4e3f-b383-
70d1b14f3011&Health_Literacy=2

19. Recommendations for Integration
• Initial introduction—didactic with active learning and audio-video
tools
• As early as possible in the program
• Pair with existing principles of patient education (teaching
and learning)
• Clinical Setting, clinical evaluation tools
• Simulation

20. Q & A:
What questions do
you have?

21. References
• Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J.,Viera,A., Crotty, K., Holland,
A., Brasure, M., Lohr, K. N., Harden, E.,Tant, E.,Wallace, I., &Viswanathan, M. (2011).
Health literacy interventions and outcomes: an updated systematic review. Agency for
Healthcare Research andQuality (US); Evidence report/technology assessment, (199), 1–
941 Available from: https://www.ncbi.nlm.nih.gov/books/NBK82434/
• Coleman,C., Hudson, S. & Maine, L. (2013). Health literacy practices and educational
competencies for health professionals: a consensus study. Journal of Health Communication,
18, 82–102. doi:10.1080/10810730.2013.829538
• Coleman,C., Hudson, S., & Pederson, B. (2017). Prioritized health literacy and clear
communication practices for health care professionals. HLRP: Health Literacy Research and
Practice, 1(3), e90–e99. https://doi-org.proxy-
hs.researchport.umd.edu/10.3928/24748307-20170503-01
• Hernes, K., & Ott,V.(2018). Health literacy education for undergraduate health professions
students: A call to action. HLRP: Health Literacy Research and Practice. 2(3) e163-e165. doi:
10.3928/24748307-20180726-01

22. References
• McCleary-JonesV. (2016). A systematic review of the literature on health literacy in nursing
education. Nurse Educator, 41(2), 93–97. https://doi-org.proxy-
hs.researchport.umd.edu/10.1097/NNE.0000000000000204
• Saunders, C., Palesy, D., & Lewis, J. (2019). Systematic review and conceptual framework for
health literacy training in health professions education. Health Professions Education, 5(1), 13-
29, https://doi.org/10.1016/j.hpe.2018.03.003
• Scott, S. A. (2016). Health literacy education in baccalaureate nursing programs in the United
States. Nursing education perspectives, 37(3), 153–158. https://doi-org.proxy-
hs.researchport.umd.edu/10.1097/01.nep.0000000000000005
• U.S. Department of Health and Human Services (2010). National action plan to improve health
literacy. Retrieved from https://health.gov/sites/default/files/2019-
09/Health_Literacy_Action_Plan.pdf
• U.S. Department of Health and Human Services, Office of Disease Prevention and Health
Promotion. (2020). History of health literacy definitions. https://health.gov/our-work/healthy-
people-2030/about-healthy-people-2030/health-literacy-healthy-people/history-health-literacy-
definitions