In this episode, you’ll learn one way health literacy can be a stumbling block. And it might not be the one you’d expect! You’ll also learn three ways around this ‘stumbling block.’
I recently talked about health literacy in a session titled: “The Stumbling Block: Health Literacy.” The overall theme was building blocks, which I thought was clever and fitting, focusing on resources. There are a few implications in a title like “The stumbling block: health literacy” and in this episode I’m going to look at one of them. Specifically as it relates to patient or client education. And I’m going to end with three tips to help you get around that stumbling block.
As providers, you want patients to have health information in a way that they can use. You want to share what you know, in a way that will make a positive influence on patients’ lives, in the short and long term. You know that health literacy has to do with patients’ understanding of health information. And so, clever people that you are, you figure that health literacy somehow plays a part in patient education. And you’re right; it does.
More than you may think. Certainly more than you’ll learn from me in this short episode. But I will dig in here and offer some thoughts about how health literacy can present a kind of stumbling block in patient/client education. And it might not be the one you think.
As you may know, I’m particularly interested in what language, literacy and education have to do with each other in (and beyond) the health sector. So I’ve been keeping an eye on the implications of health literacy research for the practice of patient education.
just a reminder, I made an audiobook bundle called Effective Patient Education. It’s a bundle of an 80 minute audiobook, an 40 page ebook to follow along, research references, and additional resources. It’s inexpensive and you’ll be helping support this podcast series and your own learning. Available for immediate download on healthcommunicationpartners.com.
In summer of 2017, the NAM made an argument in a Discussion Paper for what health literacy, health education, and health communication have in common:
Health communication, health education, and health literacy are rooted in a common understanding of human communication and share the goals of enhancing human health, improving health outcomes, and reducing health disparities.
The fields of health communication, health education, and health literacy share the idea that strategic communication—using the tools of spoken, written, and gestured communication in a variety of cultural settings—can help individuals, groups, and whole systems grow, learn, and make positive health decisions. (“Improving Collaboration among Health Communication, Health Education, and Health Literacy”)
The authors draw a strong line connecting the (sometimes silo’ed) fields of health literacy, health education, and health communication, and make a compelling case for collaboration among them. I’m using these statements as a grounding for what I’ll say about the stumbling block.
Health literacy is a relatively young field, and has seen explosive growth in the last 10 years. Health literacy research has helped raised awareness of many issues related to patient education. Eliminating jargon is important, and you’ve been doing that. Providing the same message in multiple formats is also key to patient education, and that’s happening especially in the digital realm.
There is awareness that health literacy involves interactions between and among individuals; between people and materials; and between people and contexts.
Health literacy research asks providers to recognize that improving health outcomes involves understanding their patients’ thinking, knowledge, resources, and goals. And there’s much more that health literacy research has brought to the fore – issues involving providers, patients, materials, contexts, and policies.
But can health literacy get in the way of patient/client education?
Patient education is a relentlessly complex endeavor. You educate patients under (sometimes unbelievable) constraints. You often have a great deal of complexity to work with. And everyone learns differently. Add to this the fact that there can be subtle pressures against thinking about your patients as capable learners. Sometimes, patients can be framed or positioned in negative ways by well-meaning research, theories, practices, or policies. And health literacy is no exception. These taken-for-granted arrangements can become part of institutional norms, and creep into providers’ everyday actions.
For example, a nurse manager recently told me how upset she was, when she looked at a patient chart and saw that her patient was identified as illiterate. She was unsure how she should approach the patient. In talking to me, she seemed disappointed in herself, and the fact that she did not know what do to as she began the patient encounter. As we continued talking, she realized that the one word “illiterate” had negatively impacted her thinking about the patient as a person. She suddenly seemed too different.
“Illiteracy” (I’ve pointed out before) has been used as a pejorative term for decades, and “illiterate” can quickly take on negative connotations, too. Labels such as this can conjure images of someone unintelligent, uninformed, backward, or somehow lacking in what’s necessary to function in the modern world. This is as untrue as it is damaging. Unfortunately, people who are repeatedly told they are illiterate come to believe these things about themselves. The relationship between patient and provider was damaged here, as well.
In another example, I was talking with a client about patient education materials. One of the first things clients tell me when I get ready to look at their materials is the ‘reading level’ they have. Reading levels are easy to calculate and they do draw attention to some important stylistic faux pas, such as too many overly-long sentences. But when I mentioned that The Joint Commission recommends health information be written at a fifth-grade level or lower (Grabeel et al, 2018), she responded, “Then I have to write this for an 11-year-old.”
Whoa there! Of course she doesn’t have to write her materials for an 11-year-old. That is not the point. Her audience is not children. But it’s understandable, when someone hears ‘fifth grade,’ to think ’11 year old.’ Again, suddenly, the audience seemed too different. Children, rather than adults. Reliance on ‘reading levels’ is problematic – in part because of such implications. Anything that makes you feel more distant from your patient can make patient education seem more difficult and daunting.
So what can you do? Let’s close some of that distance. Here are three quick reminders:
#1 Everyone can learn.
Let yourself reconsider any theory, policy, strategy or research that implies some people can’t learn. Or are not learning, no longer learning, or not interested in learning. Many studies prove that even people who are labelled as illiterate by one measure or another draw on a broad range of strategies when it comes to literacy and numeracy activities. They have multiple sophisticated ways of reading a text or image, keeping track of items, measuring and weighing, estimating and calculating. Be on guard for implications that ‘those kinds of people’ just can’t learn.
#2 A patient’s health literacy level is not a proxy for education. A patient’s health literacy level is not a proxy for intelligence.
But it can be treated in that way, albeit unintentionally. It may be more helpful to think of health literacy as someone’s savvy with certain kinds of information, certain terms, and certain systems. ways of doing things that are specific to a certain context, and known to insiders in that context.
#3 Approach your patient as someone who uses language in sophisticated ways in their everyday life. Because they do! Speak with this assumption in mind. You’ll feel less disconnected from your patient, and can focus on the task at hand.
I’m a fan of yours (and of health literacy and patient education, if that’s not already obvious). So please reach out to me for support in the work you do around health literacy and patient education.
This has been 10 minutes to better patient communication for Health Communication Partners. I’m Dr. Anne Marie Liebel.