Give staff skills to teach low-literacy patients

Methods will increase learning for all patient types

During training sessions on how to more effectively teach patients with low-literacy skills, staff members at health care facilities mention several barriers, explains Sue Stableford, MPH, MSB, director of AHEC Health Literacy Center at the University of New England in Biddeford, ME.

Staff constantly are pressured to do more in less time and have tremendous charting requirements.

Patients generally are very sick when admitted to the hospital, and then discharged quickly. Therefore, it is difficult for the patients to learn the many skills they need for a safe discharge. Also culture and language issues can complicate the patient-provider interaction.

"People bring different perspectives to the amount of information they want and what they think they need. A clinical care provider may well have ideas about what the patient is going to need to know to manage his/her care, but the patient may be more worried about other things at that moment so there is a discontinuity in priorities," she says.

To help overcome these barriers to teaching, Stableford recommends organizations use the teaching strategies suggested by the Chicago-based American Medical Association as part of their health literacy campaign:

1. Slow down and take time.

Health care professionals familiar with the topic often talk too fast to patients who may know nothing about their condition, notes Sandra Cornett, PhD, RN, director of OSU/ AHEC Health Literacy Program at The Ohio State University in Columbus.

2. Use plain, nonmedical, everyday language.

It is important to use lay terms when discussing health problems and treatment, she says.

3. Show or draw pictures and use other teaching tools whenever possible.

Having tools available for teaching, such as models or drawings, will help people visualize situations, says Janet Ohene-Frempong, MS, president of JO Frempong & Associates, a plain language and cross-cultural communications consulting firm based in Elkins Park, PA.

4. Limit the amount of information provided and repeat it.

"I tell staff to come up with two or three messages so they have the time to repeat them, and make sure that patients understand rather than cover five to eight points only once. Therefore, the staff need to prioritize the most important things for the patient to know," Cornett notes.

It’s also a good idea to frame the message, she says. The educator needs to tell the person what is going to be taught. For example, he or she would explain that the lesson would cover three points about diabetes, and then briefly state what they are. Once the patient understands the lesson, the educator can go into more detail on each point. "We find ourselves giving too much information and not organizing it in a way that helps people learn. Also, we overteach to some degree and give too much information too rapidly for most to grasp," Cornett continues.

5. Use the teach-back or show-me technique.

Don’t say, "Do you understand?" or the patients will just nod their heads. Say, "Show me how you will be giving yourself your insulin every day," Stableford explains.

6. Create a shame-free environment.

In a shame-free environment, patients feel comfortable asking questions. They know their questions are welcome, and it is OK to take time to learn, she says. "Make it safe for people to express confusion, give people permission to not understand," adds Ohene-Frempong.

A good way of organizing the patient-provider interaction is to use the AskMe3 model, she says. This model encourages patients to ask and health care providers to answer three questions: What is my main problem? What do I need to do? Why is it important for me to do this? The model increases the likelihood that patients actually will get something out of the patient-provider interaction and physicians will give as much information as possible in the limited amount of time they have, Ohene-Frempong explains.

At the end of a teaching session, it is a good idea to give patients written information summarizing or supplementing the teaching session, Stableford notes. That way, patients leave with a better understanding of what they need to do.

Of course, the first step in teaching patients is to assess for learning barriers, and at this time, health literacy could be evaluated, Cornett says. The best way to assess for low health literacy is to look for clues. Often patients will give excuses for not reading the pamphlets they were given. Also, if they fall into the patient populations more likely to have literacy problems, such as the elderly or those who speak English as a second language, the educator might apply the skills for teaching low-literacy patients.

However, the methods for teaching patients with low health literacy are excellent for all types of patient teaching, Cornett adds. "There is no magic bullet [to] use with people with low literacy. A lot of the strategies would enhance teaching anybody. For example, using common words consistently or making sure your terms are defined," she explains.