Program targets clear communication between health care provider and patient

Ask Me 3 aimed at patients with low health literacy to improve outcomes

To introduce Ask Me 3, a new patient education program created by the Partnership for Clear Health Communication and designed to promote communication between health care providers and patients, Sharon Allison-Ottey, MD, CEO of COSHAR Medical Inc. in Lanham, MD, and Baltimore invited staff to a brown-bag lunch.

The Partnership for Clear Health Communication, funded by New York City-based pharmaceutical giant Pfizer Inc., is a coalition of national organizations that are working together to promote awareness and solutions around the issue of low health literacy and its effect on health outcomes.

At the luncheon, Allison-Ottey talked about health literacy and the importance of answering the three questions promoted by the program so that patients understand and act on health information to improve health outcomes. While certain groups may find it difficult to understand medical information — the elderly, those who speak English as a second language, and people with poor reading skills — anyone can have difficulty understanding health care information.

According to the partnership, low health literacy may be a factor in the high use of some health care services. It is estimated that low health literacy costs the U.S. health care industry $73 billion annually and puts one in three people at risk for poor health outcomes.

The three questions selected to improve health literacy by the partnership steering committee, of which Allison-Ottey is a member, are:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

"Even if the patient doesn’t ask the questions, we train staff to make sure they hit these three points," says Allison-Ottey.

In addition, staff give the Ask Me 3 brochure to patients and family members who accompany them on their office visit. Also, staff discuss the three questions with patients. At the end of the visit, many physicians ask patients questions to make sure they are clear about their health problem, what they need to do, and why it is important that they follow the physician’s instructions.

"I believe it is important to educate both staff and patients so there can be active streams of communication back and forth. In the patient and health care provider exchange, these three questions really need to be discussed," says Allison-Ottey .

Get everyone on board

With both parties focused on the answers to three questions, patients are more likely to understand what they need to do, says Matthew Scelza, statewide program director for California Literacy in Pasadena, which is one of the organizations in the partnership.

Usually during an office visit, a physician might give 15 pieces of information and advice, yet the patient probably only will remember a couple points made. Yet when patients get clear answers to three questions, they are more likely to comprehend it.

"They may end up getting less information from the doctor, but it will be more useful and — more importantly — be easily remembered by the patient," Scelza says.

California Literacy implemented the Ask Me 3 program in May 2003 when it was released. Adult learners in the literacy program are given the materials after a discussion about their experiences in the medical setting. Many people who struggle with literacy say they do not know what to say during a doctor’s visit and they feel "dumb," Scelza notes.

In the adult literacy classes, a poster with the three questions is hung at the front of the classroom, and the students go over the questions. Often the instructors will have people in the class role-play so they become comfortable asking the questions.

Scelza says that in a health care setting, the patient brochures might be introduced during support group sessions or community outreach classes.

Sandra Cornett, PhD, RN, director of the OSU/AHEC Health Literacy Program at The Ohio State University in Columbus, planned on implementing Ask Me 3 in October 2003, which was health literacy month. She had too many health literacy workshops and was unable to fit it into her schedule. However, Cornett hopes to introduce it in a couple clinics at The Ohio State University Medical Center as pilot projects.

She will first speak to the managers of a health care setting during a staff meeting because without their support, the program will not work. "I will probably use the Ask Me 3 brochure that introduces the health literacy problem to management as well as some of the other materials that I have," says Cornett. Once managers are on board, she will train staff.

"The benefit of the program is being able to raise people’s awareness, particularly the provider in an organization, that health literacy is a problem that is costing money and affects health outcomes," she reports.

In the current health care environment, patient empowerment is important and most health care organizations proclaim to encourage patients to ask questions. However, some nonverbal behavior, a sense of urgency, and the numbers of people whom clinics see in one day prohibit questions, says Cornett.

While Ask Me 3 will help encourage questions, staff also must take the time to assess learning as well. Cornett advises the use of the teach-back method. With this method, the provider might say, "I am not sure I covered all the material; could you tell me what I told you so I can make sure I covered everything?" Or the provider might say, "How would you go about explaining this treatment to your family?"

Providers also must be taught to speak clearly to patients in terms that they will understand, says Scelza. While Ask Me 3 is a great tool, if providers answer the questions in complicated medical jargon, patients will not know what to do, he adds.

Context also is important with literacy, adds Cornett. Practitioners must frame the message within the context of a patient’s experiences and lifestyle.

"When we trained staff, we talked about making sure that we took off the doctor’s cap or the nurse’s cap and broke down some of the words in language that people understand. It is important to answer in ways that people understand and to personalize or individualize the information," says Allison-Ottey.

[Editor’s note: The Partnership for Clear Health Communication and its individual members are committed to offering free and low-cost resources and programs to health care providers. Materials to implement the Ask Me 3 program are available for free download at Also available on the web site are literacy resources, explanations of clear health communication techniques, and examples of simple interventions. Telephone: (877) 427-5633.]


For more information on implementing the Ask Me 3 program, contact:

  • Sharon Allison-Ottey, MD, CEO, COSHAR Medical Inc., 8601 Martin Luther King Hwy., Lanham, MD 20706.
  • Sandra Cornett, PhD, RN, Director, OSU/AHEC Health Literacy Program, Office of Health Sciences, The Ohio State University, 218 Meiling Hall, 370 W. Ninth Ave., Columbus, OH 43210-1238. Telephone: (614) 292-0716. E-mail:
  • Matthew Scelza, Program Director, California Literacy, 133 N. Altadena Drive, Suite 410, Pasadena, CA 91107. Telephone: (626) 395-9989. Web site: