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Literacy coalitions: Fruitful partners in literacy efforts
Improve training of health care providers and consumer education
To improve health literacy, a key factor in effective patient education, medical facilities may want to consider forming partnerships with literacy coalitions in their area.
The Literacy Coalition of Central Texas, headquartered in Austin, began collaborating with health care institutions when it needed help in creating educational materials to improve health literacy among its clientele.
Adult literacy instructors teach students who are at high risk for low health literacy; therefore, it makes sense to create health literacy-related lessons or to incorporate health information into existing lesson plans, says Peter Morrison, health literacy coordinator for the Literacy Coalition of Central Texas, which is a network of literacy programs in a five-county region.
Presently, these partnerships also give the coalition an opportunity to work with health care providers to improve their understanding of health literacy and their ability to communicate with all types of patients.
Morrison says it is important to work with both consumers of health services and health care providers. Health literacy is described as a person's ability to obtain, understand, and process health information and services in order to make appropriate decisions. Good communication is always a shared responsibility between the provider and the patient, says Morrison.
"It is not only our goal to teach effective communication to health care providers, but we are training the adult literacy instructors, all of whom teach students who are at the high-risk levels for low health literacy," says Morrison.
How might patient education managers/coordinators benefit from such partnerships? Morrison says literacy programs can help form focus groups to test the effectiveness of written materials and educational programs in reaching the patient with low health literacy patient.
He adds that literacy organizations often have expertise in the area of health literacy and can save health care organizations time and money by providing information and suggestions about the needs of the local community.
They often have the demographics of the people in the area with low health literacy, who might access the local hospitals and clinics as patients. For example, in Central Texas, the population consists of those who speak English as a second language and native English speakers, says Morrison. He adds that in Central Texas, one in five English speakers can't read or write well enough to fill out a job application.
"Most of our clients fit into the high-risk populations that the American Medical Association identifies, which are elderly, low income, unemployed, minority ethnic groups, and people who speak English as a second language," says Morrison.
However, he warns that at the same time, it is important to understand that it is hard to put a face on low health literacy, because it is so widespread. He says more than one-third of the population, or 90 million Americans, struggle with low health literacy.
In addition, someone who is an expert in a professional field may have no clue about navigating the health care system or communicating with a physician. It is important not to assume that someone has high health literacy, because he or she does not fit the high-risk groups, says Morrison.
Targeting low health literacy
To target low health literacy in all segments of the population, the Literacy Coalition of Central Texas created Healthcare Provider Workshops that are customized for each group. These workshops on health literacy are for anyone in health care, from nurses and physicians to receptionists.
Health care institutions may want to look into training programs offered by local literacy organizations before duplicating efforts and creating workshops on their own.
What they would find in workshops offered by the coalition in Central Texas are sessions ranging from simple to detailed. For example, there are 20-minute presentations that introduce the importance of health literacy. Also, there are half-day, interactive workshops in which audience members participate in activities to help them empathize with patients with low health-literacy, practice the Chicago-based American Medical Association's (AMA) six steps to improved communication, and create patient-friendly materials.
"Once we have identified who is at risk for low health literacy and how you can identify patients with low health literacy we do some activities and role plays to help address low health literacy using the AMA's six steps to improve interpersonal communication with patients," explains Morrison.
The six steps advise health care providers to slow down; use plain, nonmedical language; show or draw pictures; limit the amount of information provided and repeat it; use the teach-back or show-me technique; and create a shame-free environment.
Morrison says that coalition trainings frequently offer continuing education credits for medical professionals who attend workshops on addressing low health literacy.
Experts from the Literacy Coalition of Central Texas also help health care institutions improve patient access to medical care by conducting a walk-through of a hospital or clinic to determine how easy the facilities are to navigate. Also, they pinpoint where improvements might be made. Signs can be particularly confusing, says Morrison. Families are looking for children's health and may not know the meaning of pediatrics.
"Medical language is a completely different language. People may speak English fluently but not speak medical English fluently," explains Morrison.
Paralleling the health care provider workshops, the Literacy Coalition of Central Texas offers health literacy workshops for adult education instructors.
The workshops cover the importance of teaching health literacy to adult students, which topics are important to teach in the classroom, strategies to incorporate health-related material into existing curricula, and methods for creating one's own health-related lessons.
Instructors are encouraged to cover three major areas, says Morrison. The first is health care access and navigation, to include finding a physician and understanding when it is appropriate to use the emergency department or urgent care and when and how to make an appointment at a clinic.
To aid teachers, nurses, social workers, and other professionals in helping Central Texas residents access and navigate the health care system, The Central Texas Healthcare Resource Directory was developed. The directory is designed to help community advocates make referrals for low health literacy, uninsured, or underinsured community members to appropriate health care services.
The second area of education is disease prevention by focusing on good nutrition, stress management, and regular screenings. For example, the instructor may introduce the food pyramid, and then use a grocery flyer to help students plan inexpensive meals, based on the guidelines of the food pyramid.
A third area of coverage is disease management. This curriculum helps students learn to read prescriptions labels, follow a medication regimen correctly, and know what questions to ask physicians during an office visit.
The goal of this education is to empower the patients, so they can be advocates for themselves and their families in the health care setting, says Morrison.
A joint effort
Creating a community that is 100% health-literate takes a joint effort, says Morrison. Therefore, the Health Literacy Action Group was established by the coalition. The group currently consists of 12 members with expertise and an interest in health literacy. To form the group, the coalition invited certain people from the community, such as the health educator from a clinic, a professor from the University of Texas, Austin, and the owner of a company that develops plain-language materials for health care providers. These people were told to bring others interested in health literacy to group meetings.
At the last meeting of the action group, members discussed the seven goals to improve health literacy issued by the U.S. Department of Health and Human Services as part of its National Action Plan to Improve Health Literacy.
"We shared the ways in which members of the group are currently addressing each goal. In recognizing the areas of the seven goals, which we are already addressing, we were able to see the gaps that are left and develop plans to address those issues. Overall, we have decided to use the goals as a framework for our group's development and action plans moving forward," says Morrison. (To learn the seven goals, see the story below.)
Peter Morrison, Health Literacy Coordinator, Literacy Coalition of Central Texas, 300 W 6th St., Austin, TX 78701. Telephone: (512) 320-4505. E-mail: email@example.com.