Try adult literacy groups to learn skills

Education for consumers and providers

Partnerships between health care systems and literacy groups would be a good way to improve communication between patients with low-health literacy and health care providers, says Jeff Burkhart, MS, executive director of the Literacy Network of Dane County, a nonprofit organization in Madison, WI.

"I think more adult literacy providers should be engaging with their health care systems. The health care systems really need us and our students, so they can better understand how to interact with people who may have health literacy issues," says Burkhart.

He adds that health literacy providers can be a resource for hospitals working to comply with new Joint Commission standards on communication between patients and health care providers. For example, before distributing materials to patients, health care systems might think about having an English language learner review it.

Also, health care providers might partner with these agencies to learn about the issues people with low-health-literacy have when engaging in the health care system, and how to better verbally communicate with low-literacy patients.

Literacy Network of Dane County has taken a small step to improve health literacy by implementing a program called "English for Health," which works with partnerships in the health care community. The program benefits students by teaching them how to access and use the U.S. health care system while they are working on their English skills. Health care workers benefit by learning more about the communication needs of patients who are English learners and/or have low-health-literacy.

Partnerships include the University of Wisconsin School of Pharmacy, Group Health Cooperative, and St. Mary's Hospital, and each of these organizations help supplement the core curriculum — "Staying Healthy." This curriculum was created by the Florida Literacy Coalition and covers such topics as finding a doctor, basic medical vocabulary, medications, and communication with health care professionals. "Staying Healthy" can be downloaded for free at

Pharmacy students create activities for students to better understand the information they are provided about medications. One activity teaches them how to read prescription labels. Students practice the skill by reading the label and explaining how often the medication is to be taken — and how many times it can be refilled.

Burkhart says that physicians and other clinicians in health care systems often say patients are not compliant and don't want to follow directions. However, he finds that more often the patient doesn't understand the directions.

In class, students practice understanding both written and spoken directions.

Another value-added activity is a tour of the community health center.

Recently, the Literacy Network formed a partnership with a local food co-op. During a visit to the co-op, students learned options for healthy eating habits that they could integrate into their own cultural practices, such as choosing ingredients that are lower in fat, higher in fiber, or more natural. Students had an opportunity to meet with a nutritionist from the co-op and talk about changes they might make with their diet.

Practice makes perfect

A mock clinic conducted at St. Mary's Hospital helps students put the skills they learn during the course into practice.

As part of the curriculum, students call the clinic to make an appointment, and a volunteer schedules the visit. The student must write down the appointment time and show up at the clinic as scheduled. Of course, the entire class is scheduled for the same evening.

Upon arrival, students must sign in at the desk and give the receptionist their name. A nurse meets with each student, takes his or her blood pressure, and discusses his or her health issue. All students are given a script of health issues to discuss, and nurses are careful not to give advice should the student veer from the script and ask about a personal issue.

Also, the nurse gives each student a prescription, which he or she fills at the pharmacy. At that time, they are given information on how to take the medicine and invited to ask questions.

After their visit to the mock clinic, the students fill out a form that tallies information about their experience, such as the main health issue discussed with the nurse and information given to them by the nurse and pharmacist.

At the end of the mock clinic, students, nurses, pharmacists, and everyone else involved in the event spends about 15 minutes discussing any issues in their real lives that may have been reflected in the mock clinic.

The mock clinic helps health care providers see the point of view of patients with low health literacy, says Burkhart. Also, the students are able to test their skills.

According to Burkhart, there are many examples of how the students benefit from the course. Evaluation results show that 78% of the students increased their understanding of health-related vocabulary and ways to access health care in the United States. Students also report individual accomplishments, such as cutting cholesterol through diet, having discussions with pharmacists about medication, and obtaining low-cost health care after being laid off from a job.

Having nurses and pharmacists participate in the class and talking to students about their health and communication issues helps students feel much more comfortable with interactions pertaining to health care, explains Burkhart.

Information the Literacy Network obtains from students about the difficulty in accessing health care is passed on to health care providers. Students have shared the following:

  • Signs in hospitals and clinics could be shorter, with fewer words.
  • Scientific language used in printed materials and by nurses and doctors is hard to understand.
  • In the emergency department, patients wait a long time for an interpreter. While they get in faster without one, they don't understand everything.
  • When people visit the hospital or clinic for the first time, it's confusing. Who should you talk to first?
  • Filling out forms is very difficult because of the scientific language, acronyms, and names of illnesses. Forms are easier to understand when there are fewer words, i.e., shorter sentences/phrases.
  • Better advertising for free or low-cost services and clinics is needed. It's hard to find a low-cost clinic for immunizations if you don't know where to look.
  • Students who speak English as a second language identify their need for increased training on health care topics — for example, more knowledge on common illnesses, health habits, and places in the community to go for help.

Burkhart says that representatives from health care systems in the area were invited to a meeting to discuss how to solve these issues and others. Everybody showed up, and many issues were discussed.

Health care systems must realize that poor patient/provider communication impacts the bottom line of every health care system. In Dane County, the estimates are that $544 million is lost due to health literacy issues, says Burkhart.

"If we could drive that point home, we could start to work with the hospitals and health care systems to ensure that patients do understand the information that is being given to them," he adds.

[For more information, contact:

Jeff Burkhart, MS, Executive Director, Literacy Network of Dane County, 1118 S Park St., Madison, WI 53715. Telephone: (608) 244-3911. E-mail: Web site:]