CONSULT PRN

Understanding Health Literacy RENEE L. McCUNE, PhD, RN

H

ealth literacy influences many facets of healthcare, from communication between clinician and patient, to maintaining personal health. To put the potential impact of inadequate health literacy into perspective, the first national measure of health literacy revealed a startling number of citizens in the United States with basic or below basic health literacy skills. According to the National Assessment of Health Literacy (2003), of the 19,000 U.S. citizens who participated in the assessment, 22% had basic health literacy and 14% had below basic health literacy skills. The remainder of the adults scored in the intermediate range (53%) and the smallest number were proficient (12%). This translates into 93 million people in the United States with basic of below basic literacy skills, and depending on where one lives, the percentage of people who are at the basic or below levels ranges from 30% to 40%. Clinicians who have the knowledge and skills to understand the health literacy needs of their patients can improve patient safety and quality of care. Patients who understand their personal health information make fewer mistakes and demonstrate greater followthrough with instructions. The following are common questions about health literacy.

Q: If my patient has a high school diploma, why do I need to worry about his or her health literacy? Obviously, my patient can read.

A: The National Center for Health Literacy (2003) found that 45% of those who scored in the below basic category were high school graduates. Health literacy is also more than the ability to read. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (U.S. Department of Health and Human Services, 2000). Expectations in healthcare are changing, and the activities of health promotion and maintenance are becoming the shared responsibility of the patient and their healthcare providers. If individuals are unable to understand what is taught, or prescribed, then follow-through will be poor in relation to health behavior changes and the many tasks that are necessary to manage chronic disease. Often healthcare providers label patients as noncompliant, when it may be a lack of understanding rather than willful disregard for instructions.

Q: So if I can’t depend on education level, how do I know which patients may experience low health literacy? Individuals in certain groups are at high risk for low health literacy. High-risk individuals include those who are: • elderly, • living with lower economic means,

vol. 32 • no. 10 • November/December 2014

• members of minority groups, • speakers with limited English proficiency, • living with chronic health conditions, and • experiencing high levels of stress. It is important to keep in mind, however, that members of all educational, social, and racial groups may experience health literacy challenges.

Q: Why don’t patients let their clinician know? A: Many patients will hide their low health literacy from healthcare professionals because of embarrassment, impeding delivery of health information (Parikh et al., 1996). Unidentified literacy problems become problematic because most healthcare providers overestimate the health literacy level of their patients (Bass et al., 2002). Processing personal health information can be overwhelming for many and oftentimes is delivered during a time of high stress, resulting in “missed” or misunderstood pieces of the message.

Q: Should we screen all our patients for health literacy skills? A: Although the verdict is mixed related to screening for health literacy, there are simple tools that can be used. The easiest question to ask is, “How confident do you

Home Healthcare Nurse 617

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

feel about reading?” Should you decide to use a validated screening tool, two simple ones are available: the “Newest Vital Sign” (Weiss et al., 2005) and the Brief Health Literacy Assessment (Chew et al., 2004). Both take less than 5 minutes to administer and give a quick snapshot of health literacy skills.

Q: Now that I am aware my patients may be low health literate, how do I work with them while preserving their dignity? A: Here are a few tools for all patients: • Use plain language in speaking and writing— ditch the “medicalese” and talk in “living room” language (as if you were speaking to your grandmother); • Teach patients to use “Ask Me 3” (National Patient Safety Foundation, 2014)

when talking to healthcare providers: What is my main problem? What do I need to do? Why is it important for me to do this?; • Use “teach back” or “show me”—ask the patient to “re-teach” you the information you just provided to them; • Break information into small “chunks,” starting with the most important item; and • Provide simple instructions and supplement based upon individual needs. More information and continuing education opportunities on health literacy are available on the following Web sites: • http://www.health.gov/ communication/literacy/ • http://www.hrsa.gov/ publichealth/healthliteracy/ • http://www.cdc.gov/ healthliteracy/training/ index.html

Renee L. McCune, PhD, RN, is an Associate Dean, McAuley School of Nursing, University of Detroit Mercy, Detroit, Michigan. The author declares no conflicts of interest. Address for correspondence: Renee L. McCune, PhD, RN, McAuley School of Nursing, University of Detroit Mercy, 4001 W. McNichols Rd., Detroit, MI 48221 (mccunere@ udmercy.edu). DOI:10.1097/NHH.0000000000000164

REFERENCES Bass, P. F., 3rd, Wilson, J. F., Griffith, C. H., & Barnett, D. R. (2002). Residents’ ability to identify patients with poor literacy skills. Academic Medicine, 77(10), 1039–1041. Chew, L. D., Bradley, K. A., & Boyko, E. J. (2004). Brief questions to identify patients with inadequate health literacy. Family Medicine, 36(8), 588–594. National Center for Health Literacy. (2003). National assessment of health literacy. Retrieved from http://nces.ed.gov/naal/ National Patient Safety Foundation. (2014). Ask me 3. Retrieved from http://www. npsf.org/pchc/ Parikh, N. S., Parker, R. M., Nurss, J. R., Baker, D. W., & Williams, M. V. (1996). Shame and health literacy: The unspoken connection. Patient Education & Counseling, 27(1), 33–39. U.S. Department of Health and Human Services. (2000). Health Communication in: Healthy People 2010 (2nd ed.). Washington, DC: U.S. Government Printing Office. Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., …, Hale, F. A. (2005). Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine, 3(6), 514–522.

Daily Text Messages and Nurse Follow-Up Improve Self-Management in Patients With Diabetes University of Chicago Medicine (a large academic medical center) developed and implemented a program called CareSmarts in which patients with diabetes received several text messages each day providing education on how to manage the disease and reminders to follow recommended self-care measures. Some messages asked patients to send a reply text indicating whether they were heeding the reminders. A nurse subsequently called those who consistently failed to respond and those whose responses indicated a need for assistance, working with them and their physicians to overcome obstacles to proper self-management of the disease. The program improved self-management capabilities, leading to better glycemic control, fewer medical visits, lower costs, and high patient satisfaction. The program operated successfully for 6 months beginning in May 2012, after which time it was discontinued because of a lack of ongoing funding.

618 Home Healthcare Nurse

www.homehealthcarenurseonline.com

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Understanding health literacy.

Understanding health literacy. - PDF Download Free
502KB Sizes 2 Downloads 12 Views