Putting Health Literacy into Practice

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Reflection on the Reading Activity
Norma Kenoyer
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What people may feel about their limited reading
ability

• Ashamed, embarrassed
• Less of a person
• Stupid
• Angry
• Anxious, fearful, suspicious
• Something is wrong with me

• who have never told
• supervisor 91
• spouse 68
• children 53
• anyone 19

Parikh N Pt Educ and Counseling 1996
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People may protect themselves in health care
settings

• Coping techniques
• watch other people/do what they do (86)
• pretend they can read (80)
• never ask for help (63)
• Seek help only when illness is advanced
• Walk out of the waiting room
• Make excuses
• Become angry, demanding
• Be quiet, passive

Parikh N Pt Educ and Counseling 1996
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Universal Communications Principles

• Everyone benefits from clear information
• Many patients are at risk of misunderstanding,
  but they are hard to identify You cant tell
  by looking
• Assessing reading level does not help in the
  clinical setting can offend patients

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Strategies to enhance health literacy

• Create a shame-free environment
• Improve interpersonal communication with patients
• Create and use patient-friendly written
  materials.

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Creating a shame-free, patient-centered
environment

• Attitude of helpfulness, caring, respect by
  all staff
• Easy-to-follow instructions for appointments,
  check-in, referrals, tests
• Simple telephone processes
• Assistance provided confidentially
• All staff recognize low literacy red flags

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Red Flags for Limited Literacy

• Incomplete registration forms
• Frequently missed appointments
• Skipped tests referrals
• Medication non-adherence
• Excuses I forgot my glasses
• Unable to name medications, or explain purpose or
  timing of administration
• Difficulty explaining medical concerns
• No questions

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Consider What is it like being a patient in
your setting?

• What forms will you be given?
• Will you be offered confidential assistance?
• Are check-in personnel friendly?
• Were you given easy-to-follow instructions?
• First impressions? Non-verbal staff
  communication?

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Universal Communications Principles -
Interpersonal

• Plain living-room language
• Slow down
• Break it down, short statements
• Organize into 2-3 concepts check for
  understanding (chunk check)
• Teach-back
• Ask Me 3

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Teach back

• Ask patients to demonstrate understanding, using
  their own words
• What will you tell your husband about what to do
  when Erins asthma gets worse?
• I want to be sure I explained everything
  clearly, so can you please explain it back to me
  so I can be sure I did?
• Weve gone over a lot of things you can do to
  cut down on the amount of juice Roberto is
  drinking. Can you go over what we talked
  about? How will you make it work at home?

• Do not ask
• Do you understand?
• Do you have any questions?
• For gt2 concepts Chunk and Check

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Ensure UnderstandingTeach Back

• Evidence
• Asking that patients recall and restate what
  they have been told is one of 11 top patient
  safety practices based on strength of scientific
  evidence. (AHRQ, 2001 Report, Making Health Care
  Safer)
• Physicians application of interactive
  communication to assess recall or comprehension
  was associated with better glycemic control for
  diabetic patients.
• (Schillinger, Arch Intern Med/Vol 163, Jan
  13, 2003, Closing the Loop)

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What do parents understand about giving the
antibiotic?Prose, document, numeracy skills
needed

• Give 4 ccs 3 times daily for 10
• days
• 700 A, 715 A, 730 A - before work? (shared
  context)
• Divide 3 into 24, or 12?
• Understand measurement
• (cc, ml, tsp, tbsp)
• Shared Meaning
• (3X day where to put amoxil?)

Tsp. volume range 2-9 mL
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How do I give the right dose?
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Can you please show me how many pills you will
give John in 1 day?
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Ask Me 3

• Encourages patients to ask their providers 3
  simple, essential questions in every health care
  encounter
• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?
• Providers goal should be for patients/parents to
  know the answers before leaving
• teach to the test
• it changes the way I talk to parents
• Permission from PCHC to adapt for pediatrics

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www.askme3.org
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Ask Me 3 may also

• Play an important role in creating a shame-free
  environment
• Questions welcome expected
• Make patients feel more comfortable enhance
  communication
• Improve patient awareness perception of
  communication w/ providers
• Be especially helpful among those w/ less
  self-efficacy (e.g. low literacy, elderly)

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Reach Out and Read

• Mission make literacy promotion a standard part
  of pediatric care so children grow up w/ books
  a love of reading
• At every well child visit between 6 months 5
  yrs, providers
• Encourage parents to read aloud, offer
  age-appropriate tips
• Give a new, developmentally-appropriate book
• Offer literacy-rich waiting areas
• Research shows participation in ROR results in
• More reading aloud to children
• More childrens books in the home
• Increases in receptive expressive language
  among toddlers

• www.reachoutandread.org

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Reach Out and Read

• What Did the Doctor Say? Improving Health
  Literacy to Protect Patient Safety
• 2007 Joint Commission report discusses ROR as a
• precedent for addressing literacy in health care
• vehicle for opening discussions with parents
  about literacy

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Reach Out and Read

• Primary prevention of low literacy low HL among
  children
• Secondary tertiary prevention among adult
  caregivers, helping providers explore parents
  reading comfort respond appropriately (e.g.,
  improved communication, referral to adult reading
  programs)

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