This document discusses communicating with patients with low health literacy. It outlines that low health literacy is a problem in the US and is associated with poorer health outcomes. It describes assessing a patient's health literacy level and provides ways for healthcare providers to improve communication, such as using plain language, illustrating concepts, allowing extra time, and ensuring comprehension through teach-back methods. The goal is to make healthcare information accessible and help empower patients.

1. Communication
Skills
for the
Health Care
Professional
Concepts, Practice, and Evidence
Gwen van Servellen
CHAPTER 13
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Chapter 13
Communicating with Patients of Low Literacy
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ObjectivesThe problem of low literacy in the United
StatesDifferences between literacy and functional health
literacyRelationship of education and functional health
literacyBarriers to health literacyRelationship of low health
literacy and poor health outcomes
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2. Objectives ContinuedPopulations at risk for health low health
literacyAssessing level of health literacy in patientsWays
providers can assess and enhance health literacyImportance of
using “plain language”Dealing with shame related to low
literacyWays systems of care deter or promote health literacy
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Health Literacy as a Foundation for Patient Safety and Quality
CareHealth literacy involves both patient and providers ability
to understand each otherMust 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 LiteracyRefers to the skills and knowledge
necessary to understand illness and treatment and to navigate
the health care systemLiterate patientsEmpower patients to be
active participantsMore likely to initiate and sustain important
self-management behaviorsReceive better quality health care
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3. Functional Health Literacy and Quality Care
OutcomesCumulative evidence that health literacy is associated
with Better health statusBetter treatment adherenceLower levels
of morbidity and mortalityLower use of hospitalizationBetter
use of preventive health servicesLower costs of health care
services
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Healthy People 2010Health literacy includes ability to
understandInstructions on prescription drug bottlesAppointment
slipsMedical education brochuresMedical directions and consent
formsHow to navigate complex health care systems
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Barriers to Health LiteracyIndividual level, e.g. education,
health statusPatient-provider factors, e.g. continuity of
relationship, trust and satisfaction with the relationship, shared
cultural understandingsSystem 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
LiteracyConstructs reading materials using plain language with
illustrationsTests and evaluates appropriateness of materials for
many different groupsProvider encounters exceed 6-10
minutesAdvocacy for health literacyProviders skills in
assessingOpportunities to conduct feedback loopPopulation-
based literacy best-practice program
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4. Assessing Health LiteracyREALM and REALM-RTOFLA and
S-TOFLASAHLSA-50NVS (Newest Vital Sign)
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Assessing Health Literacy (cont’d)Communication
assessmentsAvoids asking for help; quiet and
unassumingReserves questions until leaving the providerAsks
then withdraws the questionMisses appointmentsNon-adherence
to treatment planComes with companions to interpret Delays
making decisions and asks for things in writing
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Improving Patient Health LiteracyDevelop a “gestalt” of the
patientAssess health literacyAvoid shamingComprehension may
be even at 1st grade level; may not know how to readUse brief
and simple languageSlow the pace to the patientDeliver
messages in context known and valued by patient
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Improving Patient Health Literacy (cont’d)Repeat materialsUse
meaningful visuals; draw picturesUse patient’s concepts of
medical termsTell stories to embellish pointsUse feedback loop,
teach-back and close the loop
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5. 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