Teaching tips for adults with low literacy

Five steps to an improved program

The following teaching tips were assembled by Audrey Riffenburgh, MA, president of Riffenburgh & Associates in Albuquerque, NM. They are especially relevant for adults with limited literacy or limited English language skills.

• Create a detailed teaching plan.

Think through the order in which you will present the information. Begin with a connection to something the person already knows. To determine what the patient knows, ask him or her to tell you about their condition or medical problem. This step makes the learning more meaningful. Adults learn new information best when it is linked to information they already know. You can think of it as helping them find the right place to "file" the information in their memory banks.

Also, teach only the "need-to-know" information vs. the "nice-to-know."

• Prepare the patient for lesson.

When a person’s brain is prepared and alert to the topic, he or she can integrate new information more effectively whether it is verbal or in writing. Therefore, begin a teaching session by explaining what you will cover. This creates a framework or roadmap to help people organize their thoughts. For example, say, "I’d like to tell you four major things":

1. What’s wrong with you.

2. What we can do about it.

3. What you can do about it.

4. What our next steps are.

• Deliver message clearly in a variety of ways.

Use simple vocabulary even when not using medical terms. For example, use "add to" instead of "augment." This is especially important for patients who are not native English speakers. Explain the meaning of a medical term the first time you use it, keeping in mind that people with limited vocabulary may take things literally.

To make sure people don’t become confused by medical concepts they are not familiar with, be consistent in the words you use. For example, choose "high blood pressure" or "hypertension."

To accommodate learning styles, as well as varying levels of literacy and English language skills, present information in a variety of ways. For example, use pictures, slides, pamphlets, videos, and demonstrations.

• Evaluate the patient’s understanding.

After you’ve explained a point, ask patients to verbalize what you just said to them in their own words. This will give you valuable information, such as what the patient thought was important; how well the patient understood your teaching; how much background the patient may have in this area; and how well the patient understands and can use the new medical vocabulary you provided.

Review and repeat important points, emphasizing anything the patient did not cover or did not understand while repeating the information.

• Help patients overcome barriers.

Ask patients to think about the new behavior or diet, and predict what problems they may have to overcome. Help them problem solve to develop strategies for success. Discussing the potential barriers also shows you what areas they understand well and what areas you need to reinforce.

Another set of ears also is helpful. Encourage patients to bring an advocate who can help them remember later what was said. This tip is especially helpful for patients whose native language is not English.