Four Steps to Assess Health Literacy and Improve Patient Understanding
By Melissa Hagstrom, contributor
How can you be sure your patients understand the health information you pass on to them?
By focusing on health literacy, nurses and other clinicians can better help patients comprehend complex health information--something of critical importance given today’s transformative healthcare environment.
“The definition of health literacy is evolving,” explained Helen Osborne, MEd, OTR/L, president of Health Literacy Consulting and author of Health Literacy from A to Z: Practical Ways to Communicate Your Health Message, Second Edition. “It used to be about problems or lack of skills that patients had in medical settings, and it has evolved wonderfully into looking at the alignment between the demands and complexities of health care systems with the needs and abilities of patients, families, caregivers and anyone receiving health information.”
Osborne offers nurses these practical tips to assess health literacy to ensure their audiences fully understand:
1. Communicate clearly
The first step in health literacy involves clear communication, which can move beyond traditional methods of talking and writing.
“Health literacy happens when providers and patients truly understand one another. The essence of health literacy has to do with mutual understanding,” Osborne said.
Metaphors, analogies, music and stories are all communication methods that can be implemented to help patients understand and relate to health issues, Osborne added. But the most important piece of the communication puzzle is keeping language simple and concise.
“A key part of how we communicate is using plain language and consistent language. Plain language means using words, terms and concepts that people already know--or, explaining the terms clearly so they can learn them.”
2. Confirm understanding
After information is evidently communicated, the next step is confirmation of knowledge. In her talks and teachings, Osborne often tells clinicians that if they can only do one thing to improve health literacy, it should be to confirm understanding.
“It’s essential to confirm the understanding really happened,” Osborne explained. “You can communicate information, but it won’t be of any use unless the patient truly understands what they are being told.”
Nurses may be familiar with concepts known as teaching back and demonstration/re-demonstration. These confirmation methods put responsibility on the providers for clearly communicating, and make certain that information is confirmed following any key points.
“In today’s healthcare environment--with shorter appointments, more going on, people leaving sicker and sicker, and just scaling back on costs--we are asking patients and caregivers to take more responsibility for their health and wellness. And because of that, we need to be really sure that people are understanding what they need to do and why they need to do it,” Osborned explained.
3. Be creative
Pictures, drawings and other illustrations are excellent ways to help demystify complicated health issues. Visuals and models can aid in patient understanding of surgical procedures, medication management and other common health scenarios.
“Anything tactile we can touch or see can help patients understand what is going on in their bodies,” Osborne said. “We can use practice and demonstration, such as showing a patient how to look at nutrition labels or what a correct proportion looks like.”
Creativity was key in an example Osborne gave of a group of healthcare practitioners who used handheld puppets to communicate health information to a group of Chinese patients in St. Louis.
“It worked in this setting because puppets are how people have learned important cultural lessons in China for thousands of years,” Osborne said. “I don't rule out any way of communicating.”
Electronic devices such as tablets, computers and smart phones can also lend some creativity to the learning process, and can allow video demonstrations in some instances.
4. Clarify and question
Finally, nurses can validate total understanding by clarifying and questioning patients. Using open-ended questions and encouraging question-asking will stimulate dialogue and help to personalize the information.
“A good way to do this is to say to the patient, ‘What questions do you have?’” Osborne said. “This truly invites questions in the most sincere way.”
Having patients reiterate the information told to them will help identify any gaps in the knowledge continuum, while identifying any misunderstandings.
Nurses play a key role in health literacy awareness, and spreading the message doesn’t just involve the patient and/or caregiver. Raising awareness among peers, colleagues and health care administrators can help all members of the care team promote health understanding throughout all stages of the patient interaction and improve adherence to the follow-up care plan.
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