Pay attention to literacy levels
Pay attention to literacy levels
Toolkit offers guidance and support
It is no surprise that patients have trouble understanding what health care professionals tell them when you consider that 29% of the population has basic literacy skills and 14% of the population has below basic literacy skills. Another 5% of Americans are not English-literate. This means half the adults in the United States have trouble using written documents to accomplish everyday tasks, according to a report on health literacy from The Joint Commission.1
Most Americans (44%) are classified as having an intermediate level of prose literacy that means they can use information from text and make simple inferences. Unfortunately, the majority of health care information is complex and overwhelming for most Americans.
The need to communicate in language and in a manner that ensures patient understanding is important for all providers and educators, says Darren DeWalt, MD, associate professor of medicine at University of North Carolina School of Medicine and lead author of a health literacy toolkit funded by the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD. (See page 128 for description of toolkit.) "Initially, the toolkit was developed for use in primary care practices, but the tools can be applied to any setting," he says. "We were trying to put together a resource that helps an organization evaluate how well they address literacy and identify ways to improve."
The Health Literacy Universal Precautions Toolkit provides users with easy-to-follow steps to evaluate communications within the organization, steps to take to improve written and spoken communications, and resources to support implementation of a health literacy program. As the committee put together the research and tools for the toolkit, there were no surprises, says DeWalt. "We found that many organizations may endorse the use of the teach-back method, or asking patients to demonstrate their understanding, as part of their patient education program, and some nurses or educators may use it; but it is not used consistently throughout the organization," he says. Inconsistent use was true for many of the strategies included in the toolkit. "No method of improving communication is effective unless it is used consistently," he points out. "This means that it takes every doctor, nurse, and educator to apply these strategies in every situation for an organization to improve health literacy among patients," he adds.
Proof that the toolkit can be applied to larger organizations as well as smaller physician practices can be found at Carolinas Healthcare System in Charlotte, NC. The pediatrics department started out as a pilot site for the literacy toolkit while it was being tested and is now being implemented throughout the system, says Laura Noonan, MD, director of the healthcare system's Center for Advancing Pediatric Excellence. "The tools and strategies can be applied to inpatient as well as outpatient settings with minor modifications," she says.
The key to implementing a health literacy program is to incorporate teaching methods and staff education into a complete program that hardwires the organization to sustain the program, says Noonan. The best way to ensure consistent use of teaching methods and tools is to make adherence to health literacy strategies part of every employee's job description and evaluations, she suggests.
"The biggest reason for failure to successfully implement literacy programs is that we often do a lot of planning to come up with a solution to a problem, then we implement without testing," says Noonan. "The best way to implement a literacy program is to test it, tweak it, adapt it, and then implement it," she says.
One reason that Noonan likes the Health Literacy Universal Precautions Toolkit is that the evaluation process actually identifies which tools in the kit will address the organization's weaknesses. "You don't have to search through all of the tools to find the right one for your organization's needs," she says. "Instead, you have a choice of tools described as beneficial to most beneficial for your issue." By focusing on the tools that are best designed to meet your organization's issues, you don't waste time, she says. "No one will use all 20 tools, and it is important to prioritize your efforts."
There may be challenges to overcome when introducing new teaching methods, Noonan says. "It's common to hear concerns that using the teach-back method will lengthen the time it takes to educate a patient," she says. "I always point out that if you don't use teach-back, the patient will likely end up back in the emergency department and create a greater burden on our time and resources. It is always better for the organization and the patient to do it right the first time."
1. The Joint Commission. What did the doctor say? Improving health literacy to protect patient safety. Oakbrook Terrace, IL. 2007
Darren A. DeWalt, MD, MPH, Associate Professor of Medicine, University of North Carolina School of Medicine, 5041 Old Clinic Building, CB#7110, Chapel Hill, NC 27599. Telephone: (919) 966-2276, ext. 245, or (919) 966-0926. Fax: (919) 966-2274. E-mail: [email protected].
Laura Noonan, MD, Director, Center for Advancing Pediatric Excellence, Carolinas Healthcare System, P.O. Box 32861, Charlotte, NC 28232-2861. Telephone: (704) 381-6843. Fax: (704) 381-6841. E-mail: [email protected].
To access a copy of the free Health Literacy Universal Precautions Toolkit go to www.nchealthliteracy.org/toolkit/.It is no surprise that patients have trouble understanding what health care professionals tell them when you consider that 29% of the population has basic literacy skills and 14% of the population has below basic literacy skills. Another 5% of Americans are not English-literate. This means half the adults in the United States have trouble using written documents to accomplish everyday tasks, according to a report on health literacy from The Joint Commission.
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