Do you feel frustrated that your patients are often non-compliant with drug therapy? That they never seem to read food labels or properly record their blood glucose levels? Are you exasperated with telling them the same information over and over, with no change in their behavior? Try not to blame your patients, or yourself. Instead, consider that they may have low functional health literacy.
Health Literacy, as defined by Healthy People 2010, is the “degree to which individuals have the capacity to obtain, process and understand basic health information and services.”
Those most at-risk for low functional health literacy include:
• Older adults
• Racial and ethnic minorities
• People with less than a high school diploma
• Low-income patients
• Non-native English speakers
Low functional health literacy makes it difficult to read a prescription or food label, understand an appointment slip, interpret a blood glucose level, or use the Internet.
The implications of the above are costly, in patient health, as well as healthcare dollars. Those with low health literacy have increased rates of hospitalization, increased healthcare costs, poorer glycemic control and increased rates of retinopathy (JAMA 2002).
There are resources available to help you assess your patient’s health literacy, including REALM: The Rapid Estimate of Adult Literacy in Medicine (http://www.ahrq.gov/populations/sahlsatool.htm) and TOFHLA: The Test of Functional Health Literacy in Adults (http://education.gsu.edu/csal/TOFHLA.htm).
Here are some simple ways you can help patients with low health literacy levels understand what they need to do:
• Use the “teach back” method (have patients repeat, in their own words, what they need to do before leaving your office)
• Use commonly understood words (say “bad cholesterol” instead of LDL)
• Limit the amount of information that you give to your patients at any one visit
• Use oral and visual aids to help patients absorb new material and increase learning
• Be an active listener, and ask open ended questions, not those that can be answered with a” yes” or “no”
Considering only 12% of adults have highly proficient health literacy (National Assessment of Adult Literacy), the above methods can be effective with nearly all of your patients.
If you neglect to consider your patient’s health literacy before preparing educational materials, the information presented will likely be useless to your patient. For example, let’s say you hand your patient a list of websites to look into, and then ask him/her to complete two weeks of food and blood glucose records, noting the time medications were taken. A patient with low health literacy may not have the skills needed to use the Internet, and likely cannot complete a complicated record sheet. Instead, ask them to verbalize back to you one or two things they want to do before their next appointment. This will increase chances of behavior change and improve their confidence level. They might say, “I can take my diabetes medicine with breakfast and dinner every day” or, “I will eat three meals near the same time every day.” You might present them with a visual aid showing pictures of breakfast, lunch and dinner meals that they may use as a reminder.
Assessing and addressing low functional health literacy can help your patients retain more information and improve their health outcomes.
It is our duty to communicate with our patients in a way that they understand, not merely in the way that is convenient for us. In the past, I have been guilty of not fully assessing a patient’s ability to understand my instructions and “plowed ahead” with my agenda only to have my patient return frustrated. Be aware that often patients will not return to us if they are upset and don’t understand what to do; they will have the sense that we are not listening and responding to their needs.
Do you assess your patient’s health literacy? If so, how do you adjust your teaching methods? Let me know, and we can all learn from each other!
Cathy