Practice Tip of the Week: Health Literacy Month
Tuesday, October 30, 2018
Posted by: Roy Muyinza
By: Ellen Martin, PhD, RN, CPHQ
Director of Practice, Texas Nurses Association
“As clinicians, what we say does not matter unless our patients are able to understand the information we give them well enough to use it to make good health-care decisions. Otherwise, we didn’t reach them, and that is the same as if we didn’t treat them.”
- Regina M. Benjamin, M.D., M.B.A., former U.S. Surgeon General.
Health Literacy Defined
The Affordable Care Act (2010) defines health literacy as “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.”
Even highly literate people may have difficulty understanding medical jargon or a familiar word may not be understood in a medical context. Over one-third of adults fall in the basic or below basic health literacy category and may have difficulty following multiple step instructions. Only 12% of adults are proficient, measured by the ability to use a data table to identify health costs.
In a recent survey on social determinants of health, 48% of respondents indicated health literacy is one of the top five social issues that affects patient outcomes.
Health literacy is especially important in the aging population. Recently published conference proceedings report - that even high or moderate health literacy decreases after age 65 and declining cognitive function was the single most important predictor of health literacy in older adults.
Challenges in Gauging Health Literacy
One reason it can be difficult to tell when patients struggle with health literacy is that they may be embarrassed or intimidated to indicate when they did not understand something. Patients with higher levels of education may be able to repeat information back in a way that indicates comprehension, but they may leave confused.
Medication adherence can especially prove challenging, particularly when directions contain vague or contradicting statements. Even getting to appointments, booking appointments with other providers, and going to get tested or screened can be a challenge. Cultural differences also play a huge role, particularly if the patient needs an interpreter.
Strategies to Address Health Literacy
The National Patient Safety Foundation created a “Words to Watch” fact sheet to help providers substitute plain language for medical terminology. This handy tool provides alternatives for frequently challenging words in four categories:
Medical words used in healthcare settings (intermittent vs. “off and on”)
Value judgement words (adequate vs. enough)
Concept words to describe ideas (collaborate vs work together)
Category words to describe a group (cognitive impairment vs trouble thinking)
The Ask Me 3: Good Questions for Your Good Health program was designed to help patients become active partners in their health care team. It is effective because it is so simple and nurses can teach it to their patients and families. The three questions are:
What is my main problem?
What do I need to do?
Why is it important for me to do this?
Nurses play a vital role in identifying persons with low health literacy and working with the person to ensure understanding of their condition, treatments, and what they can do to improve their health. When medication is prescribed, nurses can help explain the purpose of the medicine, what it may look like, and how the patient should take it (when, how many, and with food or water). Connecting patients with navigators or giving them specific contact information for making appointments can help with follow ups or tests.
The State Health Coordinating Council state health plan update emphasizes the importance of health literacy to positive health outcomes and the impact of low literacy on a person’s ability to understand their insurance coverage. The update included a policy recommendation:
“The Legislature should charge an existing multi-stakeholder advisory committee or council, or create a new entity, to develop a long-range plan to promote health literacy in the state.”
Nurses who are passionate about health literacy may be interested in watching the SHCC committee meeting live or the recorded video archives on the SHCC website.