Why Literacy Matters
Healthcare literacy goes far beyond the ability of a patient to read or write. In fact, patients who have advanced degrees in other areas often are found to have low healthcare literacy!
When a patient is able to understand the key points of information and assimilate those concepts into their own perceptions of themselves and their health, they are better able to choose treatment options that match their own values, lifestyle and preferences. This, in turn, fosters greater trust in the medical system as a whole and can dramatically improve a patient’s sense of satisfaction with the care received. A reduction in the number of inpatient stays, length of hospitalizations and overall healthcare costs have been linked to patient education provided utilizing best practices for addressing potential healthcare literacy issues.
Like most issues in medicine and nursing care, the issue of healthcare literacy can be fraught with challenges. These include:
English as a second language (in countries with English as a primary language
Nonnative English speakers, regardless of fluency, tend to revert to their native language when stressed. Often the subtleties of options and cultural differences in practice and verbiage fail to cross over.
Those individuals who do not read or write well or who suffer from poverty are more likely to have greater needs from a healthcare literacy perspective. Often the patient’s healthcare problems cannot be successfully addressed until needs lower on Maslow’s hierarchy are taken care of.
Access to and ability to use technology
Computerized charting and apps that permit patients access to their own medical records are not useful for those who lack access to the Internet or who are uncomfortable using it.
Added to these issues are variations in patient numeracy skills. The interpretation of graphs and statistics can be confusing. Utilizing that information and applying it to self is noted to be ineffective in a healthcare literacy challenged population.
Finally, bias remains a heavy player in the realm of Internet information sharing. Web-based sources tend to market particular treatments or specific treatment centers, offering information more as an advertisement than true patient education. Particularly for health care systems and specialty pages, risk is often downplayed and benefits emphasized. This can be understandably misleading to a patient seeking information.
As nurses, our goals should align with known best practices. The extra time it takes to educate a patient adequately can be immensely fulfilling, both for the patient and for your own nursing practice. Here are some tips on best practices for educating patients with low healthcare literacy.
First, patients need assistance in identifying and communicating their core values, their tolerance for risk, and their own goals for their health and standard of living. Content shared with them should be varied and accessible, consisting of more than written handouts. In fact, most patients relate to never reading handouts that are provided. Many patients, however, report a greater understanding and satisfaction with teaching when utilizing modalities such as videos or interactive modules.
Plain Language remains best practice, with elimination of terms greater than two syllables whenever possible and complete eradication of medical jargon from any written text. Keep content to 10 words or less per sentence and three to four sentences per paragraph.
Watch for and utilize the “golden moment”. This is defined as a time when a patient asks you a question about their care. Their questioning indicates a readiness in the brain to take on new information. Expound upon your answer and provide a bit more information beyond what the patient directly asked for.
And, lastly, be sure to utilize teach back. Teach Back remains the most reliable way to assess your patient’s understanding of the information that has been provided. As you provide patient education, give the patient time to rest and ponder, then circle back to approach the topic again, perhaps from a different direction or using a different mode.
Healthcare literacy remains one of the greatest barriers to addressing recurring medical issues, particularly those which are chronic and ongoing. Diabetes, COPD, CHF, and renal failure remain repetitive causes of patient readmission; this subject has been better addressed at home with adequate patient teaching and at-home involvement by social service agencies. The increase in well days, patient satisfaction, and a decrease in healthcare spending make this a win/win situation for medical providers, our healthcare systems, and the patients themselves. I have attached some links for your perusal as you contemplate current patient education practices where you work.
FACT: An increased focus on healthcare literacy benefits everyone.
Centers for Disease Control and Prevention (CDC): Health Literacy
Centers for Medicare & Medicaid Services+: Toolkit for Making Written Material Clear and Effective