Lately, health literacy has been talked about as a process, more than just a trait an individual has. This process includes social interactions.
In this episode, you’ll learn what kinds of social interactions make up someone’s health literacy, and why approaching health literacy as an interaction is good news for your work with patients or clients.
Hi. This is 10 Minutes to Better Patient Communication, from Health Communication Partners. I’m Dr. Anne Marie Liebel.
I was talking once with a surgeon about health literacy. He said, “We’re burned by, ‘Tell ‘em what they need to know, and hope they heard.’ It’s the cultural legacy…” I appreciated his candor. He went on to make the point that he was convinced he and his colleagues could be doing better in the health literacy realm.
During the last decade, health literacy is being considered as more of a process than as something individuals have, or don’t have. A process that includes, among other things, interactions people have. Seeing health literacy as an interaction opens the door to some new possibilities for research–and everyday practice. And that’s what today’s episode is about!
Now, looking at health literacy as an interaction or set of interactions allows us more options for working with it. Options we don’t have if we see health literacy as only some trait that individuals have or don’t have in adequate amounts. When health literacy is seen as an interaction, there’s abundant opportunities to have an impact.
But what’s interacting with what? As some literacy, literature, and education folks like myself like to say: Interactions happen between and among people, texts, and contexts. Now today’s episode is called health literacy as interaction part 2. In part 1, I talked about another kind of interaction: the interaction between us and the texts we read. This time, I’m going to write about social interactions. People interacting with people, as part of health literacy.
It’s not hard to imagine person-to-person conversations as a social interaction. You may know there’s a whole research history of the analysis of the meanings, values and effects of the conversations between providers and patients.
I thought I’d focus instead on the health literacy interactions between and among patients and people outside the clinical context. Like patients and their friends, family, colleagues and social networks, whether in person or the digital kind. And then I’ll show you why this matters in everyday practice in the clinical context, and what you can do.
It is not surprising that patients’ interactions with people in the health care system can present various challenges. But this gives us some insight into how health literacy is an interaction that extends outside the health care system. One health literacy study describes the experiences of two patients who spoke English as an additional language:
“Elisabeth…revealed how, because of her level of English, she was unable to assert herself to get a dentist’s appointment over the phone.”
And another, “Navid, who had to attend the outpatient department of his hospital, explained how in the ‘big’ hospital there was no time for people to explain things to him in detail.”
It is unsurprising that social networks matter. Because when confronted with complex health-related experiences like the two I just mentioned, patients—even those with literacy difficulties–draw on friends and family to understand their situation, and to navigate the health care system.
There’s increasing agreement that family and larger social groups are part of what makes up someone’s health literacy. That same study found that:
“Health literacy is shared knowledge and understanding, it resides in the family, the neighbourhood and the social network of a patient. An individual’s health literacy could thus be seen as the sum of what she knows and is able to do on her own and what she is able to achieve with the support from friends, family and other significant people in her environment.” (Papen & Walters, 2008)
The same is true when it comes to health literacy in digital environments. One study about patient portals, health literacy, and adults with diabetes found: “Participants reported family members facilitated access and usage of HIT, taught them usage skills, and acted as online delegates.”
Teachers and classmates count as significant people in one’s social network too. A 2014 study on health literacy interventions invited adult students in ESL classes to role-play interactions with doctors, family, and friends about type 2 diabetes risk. They also shared with classmates their personal views about risk, and identified sources of reliable health information in their lives.
The study “underscores the powerful and active role that adult ESL teachers can play in the development of new health literacy skills in immigrant communities.” But in addition to the teachers in the classroom, the researchers found that “the social practices of preventive health knowledge sharing and diffusion – which occurred initially in the classroom – often can extend to contexts outside of school, in the home and community.”
It’s possible none of these research findings comes as a surprise to you. At some level, it’s as if we know that we learn in interactions with other people. So what does this mean for your everyday interactions with patients of all literacy levels?
Here’s two things you can do. First of all, find out who your patient talks to most frequently, and/or who in this persons’ life they turn to when they need help with a complex language task.
Encourage this person’s involvement! Here’s the second thing you can do.
Make sure there is something your patient can take home or access at home, and share with others (like that person!). Continue to do your best to provide information in multiple modes.
Health literacy as an interaction is especially good news because it reminds you that the pressure is off you to somehow ‘do it all’ in your time with the patient.
Yes, you will teach and some learning will happen when you and your patient interact. Yet after your visit, some learning will happen as your patient interacts with the material you share. And yet more learning will happen as your patient interacts with his or her various social groups. The learning continues when patients leave you, and that’s a good thing.
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