Eliminate written words if patients lack literacy

In-house production, video duplication control costs

It’s difficult to know if patients have trouble reading and comprehending written materials because signs of illiteracy can be subtle. Yet, flexibility is an important element of education, and teaching needs to be tailored to take into account a patient’s literacy skills, according to the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL.

There are ways for educators to assess a patient’s literacy skills, says Carol Maller, MS, RN, CHES, patient education coordinator at the Veterans Affairs (VA) Medical Center in Albuquerque, NM. Ask patients if they enjoy reading or what kind of reading they do, she suggests.

People who are readers usually will be able to discuss the magazines and newspapers they regularly read while people who are not strong readers won’t readily list their favorite publications. "It is sort of indirect questioning," she explains.

Also, health educators can keep a medication bottle handy to assess a person’s ability to read and comprehend directions. Simply hand patients the bottle and ask them when they would take the pills, says Maller.

People who have low literacy skills often have learned to compensate in other ways, and it is difficult to assess a patient’s skill level. To deal with this issue in a positive way, offer a variety of learning methods, advises Zeena Engelke, RN, MS, clinical nurse specialist at the University of Wisconsin Hospital and Clinics in Madison. Teaching methods might include video, graphics, or a demonstration with the use of a model.

Engelke finds video a well-rounded educational tool. Not only can it be used to communicate effectively with people who have low literacy skills; it can deliver certain information to all patients more effectively. In a video, you don’t have to explain as much as you do in a pamphlet because people can derive information visually and aurally. For example, you don’t have to tell people they will be taken to surgery on a cart. You can simply show the patient traveling to surgery on a cart.

"By giving people more sensory information, you can help them better understand the experience and therefore decrease the anxiety related with whatever treatment they are having," says Engelke.

Patients at the University of Wisconsin Hospital and Clinics can check out patient education videos that have been produced in-house. These include general videos on preparing for surgery, such as outpatient surgery; instructional videos, such as how to take care of drains after breast surgery; and general preparation videos, such as preparing children for the hospital.

Maller instituted a take-home video program at the Albuquerque VA Medical Center as well. "We have found that video is a great way to reach people who have limited reading skills," she says. The videos are produced in-house, so there are no copyright restrictions.

Videos are given to patients just as pamphlets are handed out, and returned on an honor system. Video drop boxes have been installed for patients’ convenience. Although the videos are not always returned, that is not a problem. Videos cost about $2.50 to duplicate, and some pamphlets that are given away cost twice as much, explains Maller.

At the University of Wisconsin Hospital and Clinics, patients often watch the videos that were produced in-house at the learning center. However, patients have the option to take the videos home to watch. A sticker on the video asks people to bring it back at their convenience.

It costs Engelke about $1,500 to produce a nine- to 12-minute video, not counting the time of staff involved in making the video. She uses a studio available at the university’s school of nursing. However, many local colleges and high schools have studios and equipment patient education managers can take advantage of, says Engelke.


For more information on using videos as an educational tool to reach low-literacy patients, contact:

Zeena Engelke, RN, MS, Clinical Nurse Specialist, University of Wisconsin Hospital and Clinics, 3330 University Ave., Suite 300, Madison, WI 53705. Telephone: (608) 263-8734. Fax: (608) 265-8848. E-mail: zk.engelke@hosp.wisc.edu.

Carol Maller, MS, RN, CHES, Patient Education Coordinator, VA Medical Center, 2100 Ridgecrest Drive SE, Albuquerque, NM 87108. Telephone: (505) 265-1711, ext. 4656. Fax: (505) 256-2870.