I recently attended a lecture on “Health Literacy and the Nexus to the Quality of Health Care” presented by Joy Deupree, PhD, MSN, CRNP, WHNP-BC. Dr. Deupree is an Associate Professor at the University of Alabama School of Nursing where she directs the Health Policy course for the DNP Program. She is actively involved in health literacy research for many projects that focus on vulnerable and underserved populations.
When I sat down for the lecture, I thought about all we need to consider regarding a patient’s literacy and how this impacts their overall health. How often do we as healthcare professionals “speak our own medical language” that patients are not familiar with? Have you considered your patient’s literacy level while educating them about new medications or providing discharge instructions? It is a topic we often let fall by the wayside due to the busy nature of healthcare, but we do need to have it in mind!
Discharge instructions are a topic that I focus on every day in my job. Asking open-ended questions of your patient will help you identify topics that they understand and items you need to focus more on with them and their family members. For example, state, “Tell me about your discharge medications you are taking?”
or ask, “Who do you need to follow up with?”
Patient’s often experience a “whirlwind” when they are hospitalized, with trying to comprehend their medical diagnosis, meeting so many healthcare providers, and being ready to go home. Make sure your patient information and the way you speak to patients is in a patient friendly language. Anytime you provide education or information to your patient or their family member, always
ask, “What questions do you have for me?”
It’s key that patients truly understand their discharge paperwork so they can have the best health outcomes.
The presentation was insightful and helped me understand much more about this often-overlooked topic. S.K. Simons coined the term “health literacy” in 1974. The National Health Literacy Act came about in 1991 by President George H.W. Bush to develop literacy skills of adults so they can function effectively in their work and in their lives. In the 2010 Patient Protection and Affordable Care Act, health literacy is defined as “The degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.” In 2015, annual health care expenditures were estimated to be $3.6 trillion (Haun, Patel, French, Campbell, Bradham, & Lapcevic, 2015). Overall, there are links between health literacy levels, poor health outcomes, and unnecessary healthcare resource utilization (Vernon, Trujillo, Rosenbaum & DeBuono, 2007).
Who are the patient populations most at risk for low health literacy? These include those who are poor, members of cultural and ethnic minorities, immigrants and non-native speakers of English, those living in the southern and western regions of the US, those with less than a high school degree or GED, and those over the age of 65. To determine if a patient has low health literacy, consider those patients who often miss office visits, fill out forms incompletely, are non-compliant with medications, are unfamiliar with medications (names, purpose, dosing; only knowing medication by its shape or color), can’t give accurate medical history, ask few questions at appointments, and lack follow-through to have tests or referrals completed.
With all of these key points to keep in mind when working with patients, here are seven things you can do as a nurse:
1. Use plain, patient-friendly language.
2. Limit information to three to five key points at a time.
3. Be specific, not general.
4. Demonstrate, draw simple pictures, and/or use models.
6. Use the teach-back method.
7. Be positive, encouraging and empowering.
Health Literacy month occurs every year from October 1st
. Take this time to focus on how you can change your practice to improve health literacy!
Want to learn more?
Deupree, J. (2019, October). Health Literacy and the Nexus to the Quality of Health Care. Lecture at Gwynedd-Mercy University, Gwynedd PA.
Haun, J., Patel, N., French, D., Campbell, R., Bradham, D., & Lapcevic, W. (2015). Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study. BMC Health Services Research, 15(249). Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-0887-z
Patient Protection and Affordable Care Act. (2010). Retrieved from https://www.govinfo.gov/content/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf
Vernon, J., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national health policy. Retrieved from https://publichealth.gwu.edu/departments/healthpolicy/CHPR/downloads/LowHealthLiteracyReport10_4_07.pdf