Knowledge of health literacy vital for role of patient education manager

It impacts almost every task required in job description

How important is knowing and understanding the issues of health literacy for the patient education manager/coordinator? Extremely important, according to Sandra Cornett, RN, PhD, director AHEC Clear Health Communication Program Office of Outreach & Engagement, The Ohio State University College of Medicine in Columbus, OH.

If a patient education manager is not well-versed in health literacy, he or she will not be able to comprehensively fulfill the roles and responsibilities of the job, she explains.

For example, most edit patient education materials that are made by the institution; therefore, they must understand the principles of plain language and how to make documents easier to read.

Also, they should implement organizational strategies to meet the challenges the system has in caring for those who may have low health literacy, which could be most of the patients and families, says Cornett.

"Research has shown that even well-educated people struggle with health information and may have low health literacy," she explains.

Organizational strategies focus on increasing awareness that health literacy is a problem by assessing the organization's current health communications and raising awareness to enlist management support.

Health communications are all forms of communicating with patients, families, and clients to help them understand their health problem or navigate the health care environment/system, says Cornett. They not only include the written word, but also oral communications, the Internet, and bills.

When an organizational audit for health literacy is done, one looks at the following areas:

• Navigation (the telephone system, entrance, lobby, staff assistance, maps, signs, and symbols).

• Print communications, including illustrations and photos.

• Verbal communications.

• Technology (TV, computers, telephones, and kiosks).

• Policies and procedures for use of print, oral communications, and staff orientation/skill building.

Focus on health communications

"I think the focus needs to be on 'health communications,' which is a bit more than health literacy," says Cornett. She explains that clear health communications goes beyond the ability to read or understand the spoken word (literacy) to looking at health systems and how the environment impacts patients' ability to understand and navigate the health care system.

"The PEM is at the forefront in these initiatives by virtue of [his or] her roles within the organization," says Cornett.

Health literacy impacts nearly all elements of the job of patient education manager, agrees Susan Kanack, BSN, RN, community outreach coordinator at ProHealth Care in Waukesha, WI. One element is the coaching of health care professionals in the best methods for educating patients, taking into account health literacy issues, she says.

"We cannot assume our learners understand everything we tell them," adds Fran London, MS, RN, a health education specialist at The Emily Center Phoenix (AZ) Children's Hospital. Therefore, patient education managers must make sure staff members have the skills to identify and teach patients with poor health literacy skills.

One way to identify patients with poor health literacy skills is to observe them, says London. Look to see if they have trouble filling out admitting forms or if they avoid reading by saying things such as "I left my glasses at home."

One way to teach patients with low health literacy is to ask them what would help, says London. Explain what skills they need to acquire for self-care, such as taking pills, and ask what would help them remember when to take them, and how to take them.

All educators must learn to evaluate understanding through teach-back and return demonstration. If patients cannot teach the information back, it means the educator needs to individualize the presentation of the content in a way the learner can understand, explains London.

This would entail modifying the information, or how it was taught, based on the learner's problem or issue. For example, the learner may misunderstand a term used or a concept. They may think "taking a blood pressure" is taking it away, so medication would not be needed. If so, the educator would need to find another way to explain the concept, such as "measuring blood pressure," says London.

Patient education managers also must develop policies and procedures that enhance health literacy, says Cornett. For example, a policy may require that health communications are tested with target audiences for comprehension.

Staff development initiatives would be another part of their job, says Cornett. For example, staff who create health materials can be taught to develop easy-to-read print copy.

Also, patient education managers would need to build health communication resources, says Cornett. This might include creating a collection of revised teaching sheets that are easy-to-read; a collection of culturally appropriate graphics; adequate interpreting and translation services; and advocating for a patient learning center if the institution did not have one.

"Ignoring the issues of health literacy would show in the lack of efficacy in your programs," warns London. "The extent and impact of poor health literacy is a factor in every socioeconomic group, not just the poor and uneducated."

Gaining insight & knowledge

If knowledge is imperative, what type of information does the patient education manager need, and how is it obtained?

Training is essential, says Cornett. Patient education managers should learn the implications of health literacy, national and local statistics, populations at risk for low health literacy, and factors that affect health literacy, such as culture, language, and age.

London says patient education managers need to be aware of the extent and impact of health literacy on health outcomes. Also, they need to know strategies for effectively teaching patients and families with poor health literacy skills. These strategies would include teaching only essential skills in order not to overwhelm the patient; highlighting key information in clearly written handouts; and making sure patients know who to call with questions and concerns.

Most individuals learn information on health literacy informally by reading resources on the Internet or going to conferences, says Cornett. Now, more formal opportunities to learn exist through courses offered by colleges and universities.

Kanack says she first became aware of the issue of health literacy years ago when a physician mentioned the "Ask Me 3" campaign. This patient education program was designed to promote communication between health care providers and patients in order to improve outcomes.

That prompted her research on the topic of health literacy, and she soon realized how far-reaching it was by the fact it had a financial impact on health care, as well as an influence on patient safety.

She contacted colleagues in the field of patient education to share information and also watched for organizations, such as The Joint Commission, to address the issue. Also, she uncovered information on health literacy through state and local councils and library research.

It is much easier to find information today, says Kanack. Now patient education managers can perform an Internet search for health literacy and find a wealth of information, she says.

Three web sites were instrumental in helping London learn about health literacy. They included: http://www.hrsa.gov/healthliteracy/ (Health Resources & Services Administration, US Department of Health & Human Resources); http:nnlm.gov/outreach/consumer/hlthlit.html (National Network of Libraries of Medicine); http://www.nlm.nih.gov/medlineplus/healthliteracy.html (Medline Plus — US National Library of Medicine and National Institutes of Health).

Now, London stays abreast of current research and posts it on her web site — www.notimetoteach.com. She says it is important to keep up on this research, because currently, it is focusing on how to most effectively and efficiently teach patients with poor health literacy skills.

SOURCES

For more information about health literacy and its impact on the role of patient education management, contact:

• Sandra Cornett, RN, PhD, Director, AHEC Clear Health Communication Program, Office of Outreach & Engagement, The Ohio State University College of Medicine, 052 Meiling Hall, 370 W. 9th Avenue, Columbus, OH  43210. Telephone: 614/ 688-3327 (Tues/Thurs) E-mail: sandy.cornett@osumc.edu. Websites: http://medicine.osu.edu/orgs/ahec/CHCP http://healthliteracy.osu.edu.

• Susan Kanack, BSN, RN, Community Outreach Coordinator, ProHealth Care, Waukesha, WI. Telephone: (262) 928-2907. E-mail: susan.kanack@phci.org.

• Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016-7710. Telephone: (602) 546-1408. E-mail: flondon@phoenixchildrens.com.