Health literacy is one of the hottest topics in health. And October is health literacy month. So this month, we’ll be featuring it around here.
A nurse manager recently talked with me about a concern she had about patients’ health literacy.
A few weeks earlier, she’d been preparing to see a patient. When looking at the chart, she saw the result of an assessment indicating that her patient was illiterate.
Seeing this made the nurse manager worried. She began second guess herself, and was even unsure how she should approach the patient. When she spoke to me, weeks afterward, she was still concerned about how she handled the patient encounter.
Patient encounters are brief and busy, and you may not have time to create solutions on the spot if you learn your patient struggles with literacy.
Health literacy is increasingly recognized as a multifaceted phenomenon, beyond an individual’s set of skills. There is awareness that health literacy involves interactions among individuals, and between people and oral, written, and multimodal texts.
This is a good thing when you’re hoping to educate a patient. Here are some research-based steps you and your colleagues can take now, to prepare for patients who may have limited literacy. And these go to 11.
First of all, literacy is complex. All people have a range of literacy skills and processes. Only a few of these are captured by any assessment.
Consider smart phones. They’re everywhere, and they require reading and writing. If your patient can use a smart phone, they have some level of literacy.
Even people who are labelled as ‘illiterate’ have sophisticated ways of reading a text or image, keeping track of items, measuring and weighing, and estimating and calculating. So don’t panic.
Don’t let a label ‘stick’ to your patient
Researchers are explicit about the fact that a health literacy assessment score is NOT a proxy for a patient’s education level. But it can still wind up being treated that way.
I don’t know what assessment the nurse manager’s patient had taken. But don’t fall into the trap of thinking your patient is uneducated, or somehow deficient, if they struggle with reading or writing.
Approach your patient as someone who uses language in sophisticated ways in their everyday life. Because it’s true.
Speak to them with this assumption in mind. You’ll feel less disconnected from your patient. You’ll be able to focus on the task at hand, rather than some perceived deficiency.
Start with what your patient brings to the table
If your patient comes to you with any information, items, or written material, talking about these is a good start. These will be items with which they are already familiar, so there may be less nervousness about their meaning or significance.
Figure out where reading/writing is totally necessary
Get clear for your sake – and your patient’s –on which parts of their visit or procedure require them to read or write.
- What reading and writing activities can be delayed? What can patients fill out or read at home with a friend?
- What reading and writing activities can be eliminated altogether? For example, is a patient being asked to provide information that has been provided before, or that is available on his/her EMR?
Have information available in multiple modes
In literacy terms, “modes” are ways of communicating meaning. Think of how videos combine images and sound. Those are two different modes.
One of the most powerful ways you can help patients learn is through mixing your modes.
This can be simple and unfussy. For example, take a written text you use frequently. Read it aloud (the voice recorder on your phone works just fine) to turn into an audio file.
Post the audio file on your website. You might offer to send it to patients’ phones for them to listen to (even while they’re with you), as most music apps will handle other audio files.
You only have to do this once, to help many patients.
Have a list of websites you trust
These are sites you believe are communicating reliable and up-to-date information. Email these to patients, share them to followers on social media, and/or post them on your site.
Bonus points for occasionally visiting a site together, side by side with a patient, and eliciting feedback!
Have a list of apps you can recommend
Apps tend to be graphics-heavy. They are also interactive. Both of these traits are beneficial for learning. Apps can also be less intimidating than pages of solid prose.
If you’re not already asking your patients if they use apps, and which ones, do so. Keep a list, both of the good and not-so-good ones. Share the ‘good’ ones with other patients. Be prepared to talk about which ones you don’t recommend.
Collect other multimedia recommendations
Keep and update a list of podcasts and videos that explain your subject matter from a patient perspective. Post links to these on your site and/or share them through social media.
Don’t know any? Ask your colleagues! Or post a question to an online community (and share your findings with them).
Know your digital communication
Be clear with patients what you use email for, and how frequently. Tell patients any connections, similarities or differences between your email and the program they may use to view their EMR. Sometimes these play well together; sometimes, not so much.
Remind patients how you and your practice use social media. Let them know if, and how, you use text messaging.
Consider the patient side: Can patients email or text your practice for information or support for the action you want them to undertake? What might they expect to see on your social media accounts?
And make sure your colleagues and staff are aware of your digital communication protocols, preferences and options. Together, you can reinforce it by talking it up with patients.
Yes, patients’ audiorecording doctor visits is one of those topics that people have strong opinions on. (Like ending sentences with a preposition.)
Whatever your opinion, it’s legal in 39 states. So your patients may be doing it, or thinking about doing it, anyhow.
If you are ok with patients recording their time with you, I suggest you bring it out into the open. Tell them it’s ok with you, and invite them to record, if they wish.
Take a look at your written materials
How long has it been since you looked at the written materials you give to patients?
Make sure written materials are accompanied by images, and broken up into small paragraphs (like this article is!). Everyone finds this more manageable and memorable.
How you physically handle and talk about written materials matters to the meaning people take from them. Handle a document with seriousness, and people will notice. Highlight or underline important passages, and talk about them or point to them.
These 11 health literacy hints also play well with what you already value about patient-centered care, and good communication overall. The more ways you can communicate a message, the more tools you’re offering all your patients to learn in a way–and in a context–that supports them best.
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