Guide offers ideas to improve health literacy

Focuses on partnerships

A project in British Columbia has resulted in a list of strategies that can be used in a primary care physician office and an adult literacy program to improve health literacy among patients.

The strategies include actions for health care professionals, patients, and community agencies. They are available on the British Columbia Patients as Partners web site, so the materials are accessible to everyone. (

The ideas were developed as part of a collaborative community effort on health literacy. It included four teams from urban and rural communities. Teams consisted of a family physician's office, both physician and office assistant, as well as representatives from an adult literacy program that included instructors and students. Teams were given support from the regional health authority.

The purpose of the project was to show how health care can be improved and to initiate effective ways to improve patient-doctor communication from the perspective of both doctors and patients, explains Susan Cathcart, FFC, CPC, the community literacy outreach coordinator for Burnaby in British Columbia, who served on the team. Also, the collaboration was designed to improve patients' health outcomes by increasing their understanding and motivation for self-management of their medical conditions, she adds.

According to Connie Davis, MN, RN, senior faculty, Patients as Partners Impact BC and co-director of the project, the teams met three times for presentations on health literacy, to learn methods for making improvements, and to become more familiar with varying points of view. They also had one final meeting.

During discussions, health literacy program coordinators said most of their curriculum focused on work preparedness, such as creating budgets, filling out job applications, and interviewing skills. Yet students were bringing prescriptions to class, because they did not understand them, or they were going to have a medical test and did not know how to prepare, says Davis. Therefore, the teachers in these programs were beginning to see that there were things they could do to improve health literacy.

Between meetings, the participants worked on projects that might improve health literacy. For example, materials on helping people prepare for physician visits were distributed to libraries and seniors groups to teach community members.

Physicians' offices were introduced to "Teach Back" as a way to confirm understanding of what was taught. With this method the physician or nurse would ask "Could you tell me what you are going to do based on what we talked about so I know if I was clear?" rather than simply asking "Do you understand?"

Teachers in literacy programs tested materials in their classrooms. For example, they presented information on H1N1 and evaluated the students on their understanding. They found that the majority understood most of the information, but not completely. Therefore, they saw the importance of determining what was not clear and going back over that information, says Cathcart.

Ideas from which to work

Following literature review, discussions, and trying various methods to improve health literacy, the group created a document titled "Improving Health Literacy in Communities, Guide to Ideas." There are three strategies — relationships, understanding, and partnering — with key elements for making improvements in those areas. Each element has advice for health care professionals, patients and families, and community groups.

The collaborative identified two key changes needed to build relationships between health care providers and patients. One was to understand and consider values and preferences. There were several recommendations made under this category.

Health care professionals were advised to match teaching approaches to learning styles, such as using pictures for visual learners, and to try to understand the environment in which people live by asking about their work and day.

Patients and families were advised to know if they prefer to learn by reading, hearing, or seeing and to tell health care professionals how their life influences their health.

Community groups were advised to provide training to patients about how to communicate with the doctor and to understand the doctor's practice, such as time restrictions.

The second strategy, understanding, focuses on accurately sharing and processing information in an interaction between the health care provider and patient. Five key changes were identified to improve understanding.

One was follow-up after a new diagnosis or medication. Recommendations for health care professionals included the creation of an information system for follow-up, such as a tickler file or electronic record. It was suggested that patients and families use a log to monitor how a new treatment was working and to bring it to visits, and to use medication schedules or aids, such as pillboxes. Community groups were encouraged to provide opportunities to discuss how to follow up with health care professionals about previous visits.

The third strategy discusses partnering for better health care. In this category, there were three key changes. One, for example, was to use accessible, supportive community resources.

Health care professionals were told that one way to do this was to assess patients' needs for resources, such as transportation or finding a personal doctor. Patients and families were advised to let health care professionals or community groups know if help was needed. Community groups were told to help identify trustworthy sources of health information.

To help set areas of the plan in place, health care professionals should talk to various agencies within the community that might educate patients on the components for change. And these agencies could implement some of the areas of change, says Cathcart.

Davis says one way to find groups willing to participate in ideas for change would be the places where people gather, such as local churches, food banks, and senior groups.

She says that more and more people are talking about universal precautions to health literacy. In other words, this approach assumes that everyone at some point in time will find something they don't understand. The ideas in the guide would prepare people and health care facilities for successful encounters in advance.


To find out more about implementing changes within this guide, contact:

• Connie Davis, MN, RN, Senior Faculty, Patients as Partners Impact BC, 450-1385 West 8th Ave., Vancouver, BC V6H 3V9. Telephone: (604) 742-1772. E-mail: