By Jean Robillard / Guest Editorial
We’ve all been there – at the doctor’s office, listening carefully and perhaps taking notes while your diagnosis is being discussed, and, yet you get home and realize that you’re still unclear as to your treatment options. Or perhaps you’re frustrated trying to decipher and fill out hospital forms that contain difficult medical jargon and unrecognizable acronyms.
These situations occur more often than health care professionals would like, and highlight an important issue facing the health care system today: health literacy.
Over the past 15 years, much research has been done to try to understand how to approach health literacy. In 2003, the U.S. Department of Education assessed more than 19,000 Americans, and found that nearly 90 percent of U.S. adults are less than proficient in reading. About 22 percent of those had basic health literacy skills, while 14 percent had below-basic literacy skills.
The study identified a significant health literacy gap between patients and their caregivers that affects patient compliance and safety. Without understanding their diagnosis, treatment options and care plan, patients are unequipped to make care decisions, and may not understand what they need to do to get well and stay well.
The research results have been so striking that in 2010 the Plain Language Act was passed. The law requires all government agencies, including health care agencies, to communicate with patients at a level they can understand. Furthermore, as part of the Affordable Care Act, insurance companies are now required to explain their policies and benefits in plain language as well.
Those of us in the health care industry are working hard to close the health literacy gap – as we must do – because we understand the consequences that can occur when we don’t communicate in a way that patients and families can understand.
According to the American Medical Association, low health literacy is a stronger predictor of a person’s health than age, income, employment status, education level or race. Disparities in health literacy, including a lack of comprehension about health care alternatives, basic self-care, medication compliance and appropriate preventive measures, exacerbate chronic conditions, cause hospital re-admissions, limit the use of preventive screening and frustrate patients and providers.
It’s important to note that poor health literacy is not only the result of a person’s education level. While illiteracy, limited health care access, poverty, language, cultural and other barriers do affect health communication, other factors may be at work too, including a patient’s emotional state, fear and anxiety. Some diagnoses and treatments are difficult to hear, regardless of the patient’s literacy level.
While it’s not always easy to communicate in a simple way, health care professionals can do better by presenting health information that people can use effectively. We need to reduce health literacy barriers and engage patients. In fact, many guidelines for best practices are in place to help institutions and individuals meet the challenge of low health literacy.
Here in the Corridor, UI Health Care developed its Patient Education Office to address health literacy. Among other things, the new office created a policy and procedural manual to enhance patient safety and compliance with health care instructions by standardizing plain language processes for patient and family education.
The plan uses plain language principles for written and verbal communication, as well as the “Teach Back” method to assure the patient’s understanding. One example of a plain language solution comes from the Iowa Department of Public Health’s literacy project, Plain and Simple (www.idph.state.ia.us/PlainAndSimple). Instead of “Reduce your sodium intake to manage your hypertension,” the plain language version would be “Cut down on salt. It will lower your blood pressure.”
Other effective teaching strategies in UI Health Care’s policy manual include everything from speaking so others can understand using “living room” level language, to recognizing that people learn in many different ways and at varied speeds. It encourages users to teach at the right time – when the patient is receptive – to start the educational process as soon as possible during the visit and to prioritize “need-to-know” information.
On a broader scale, the U.S. Department of Health and Human Services established the National Action Plan to Improve Health Literacy (www.health.gov/communication/hlactionplan) in 2010. The plan is based on the principle that all people have a right to health information so they can make informed decisions. It also emphasizes that health care services should be delivered in ways that are “understandable and beneficial to health, longevity and quality of life.”
Patients will benefit from a better understanding of their medical care through simpler, clearer communication, which they can use to make appropriate health decisions and to follow medical advice. By embracing best practices in health literacy, organizations and individuals can help transform the health care environment to provide safer, high-quality, patient-centered care, and to help reduce health literacy disparities moving forward.
Jean Robillard is vice president for medical affairs with University of Iowa Health Care.
