Most practicing primary healthcare providers have had a patient who has had no clue about what you had just explained to him or her. I had an occasion when I had just spent 15 minutes talking to a college-educated mother whose child had just been diagnosed with asthma. I carefully explained that I was going to make arrangements to have a nebulizer delivered to her home so that she could start the appropriate treatments. The home health agency later reported to me that she was quite shocked to learn that the medications given to her at the pharmacy were not to be given to her infant by mouth. She apparently was under the impression that the nebulizer was a humidifier. We get so involved in delivering a message that we do not always realize that it was not being understood.
A patient’s ability to read, understand, and apply health-related information plays a huge role in the effectiveness of both oral and written patient education. This concept of health literacy has been recognized as a key contributor to health for many years. In 2003, for the first time, the National Assessment of Adult Literacy (NAAL) measured health literacy among American adults. The results were eye-opening. Only 65% of adults scored at an intermediate or proficient level of health literacy. Some 14% (30 million) adults scored below the basic level, and another 22% (47 million) scored at only a basic level.1
A systematic review of the literature in 2012 indicated that low health literacy is linked to worse health outcomes and poorer use of healthcare services.2 This includes higher rates of readmissions and emergency department use and lower use of preventive care. The authors of the review also concluded that there was emerging evidence that lower health literacy could also partly explain the racial and ethnic disparities in health outcomes
The NAAL survey in 2003 indicated that race, ethnicity, and socioeconomic status were risk factors for poor health literacy. About 35% of Hispanic adults, 19% of Black adults, and 43% of adults living below the poverty threshold scored below the basic level in health literacy, compared with 14% of all American adults participating in the survey.1 According to Sylvia Mathews Burwell, Secretary of the U.S. Department of Health and Human Services, “If we want health equity, we need to make health literacy a priority.”
Interventions that address low health literacy may help to reduce these disparities.3 Learning these strategies will help you to communicate effectively with your patients, and they will have better health outcomes. What are some things that you can you do to make sure that your patients understand you?
1. Make sure that you can identify patients with low health literacy. Healthcare providers are notoriously poor at identifying patients with low health literacy.4 In addition, patients with reading problems often do not disclose their illiteracy.5 Some signs that a patient may struggle with literacy include poor compliance with treatments and appointments, confusion about medication, and making excuses for not reading. A great way to check the health literacy skills of a patient is to do a medication review. Ask your patients to explain the purpose of their medications and show you how they are using it.
2. Make sure to use plain language. Using plain, nonmedical language can enhance understanding dramatically. Using the patients’ own terms for their illness and treatments is a good starting point. We often need to be reminded of alternative language for our familiar medical terminology. For example: “pain-killer” instead of “analgesic”; “birth control” instead of “contraception”; “keeping bones strong” instead of “preventing osteoporosis.” Try giving simple explanations for medical terminology that you do use. Analogies can also be helpful.
Avoid acronyms. Instead of saying, “The tests show that you have had an MI,” say “It looks like you had a heart attack.”
Using plain language for nonmedical words is also useful: “Use” instead of “utilize”; “end” instead of “terminate”; and “try” instead of “attempt.”
3. Learn how to focus the message. Less than half of the information provided during a typical medical encounter is retained by the patient, even if the patient is proficient in health literacy. Limiting the information by focusing on only 1 to 3 key messages per visit is crucial. Patients who struggle with health literacy will respond more to information that is designed to promote action rather than to detailed explanations and facts. Focusing the key messages on behavior instead will help to motivate and empower the patient. Developing short explanations for common diagnoses and treatments will help you to avoid giving the patient a lecture on pathophysiology and pharmacology.