October is Health Literacy Month. In this blog post, IHI Executive Director Frank Federico describes what care providers should do to improve their communication with patients to help improve the safety and reliability of care.
The Institute of Medicine defines health literacy as “the degree to which individuals can obtain, process, and understand the basic information and services they need to make appropriate health decisions.” Studies
show that health literacy is a strong predictor of health status. Inadequate health literacy can lead to numerous negative effects on an individual’s health and well-being, including poor self-care, increased utilization of health services, worse outcomes, and decreased likelihood of receiving preventive care and services. Poor communication with patients also contributes to unnecessary readmissions and reduced patient satisfaction and engagement.
Health information can be confusing even for those with advanced literacy skills. It’s easy for those of us working in health care to forget that we speak our own language that patients can’t always easily understand. Most of us can recall times when we believed that we shared information with a patient and family member or caregiver and assumed they understood our instructions, only to later discover confusion or misunderstanding.
I teach a session on health literacy at a local college of pharmacy, and share examples from my own time in practice as well as many examples found in the literature. One example I share with my students is a study in which researchers asked patients what they knew about diuretics (more commonly known as fluid pills). Fifty-two percent of the respondents believed that fluid pills caused fluid retention instead of alleviating it. Another example I use is the story of a patient who was informed that she had Grave’s disease, and burst into tears because she thought the doctor was telling her she was about to die.
This kind of confusion is understandable, but may also be avoidable if we take some extra care with our communication with patients and family caregivers. There are a number of ways care providers can improve their communication, to help patients and families better understand health information. Here are eight suggestions, to start:
- Ask open-ended questions to assess the patient’s understanding of written materials, including prescription labels.
- Use the Teach Back communication method to determine if a patient has understood your instructions and can repeat the information in their own words.
- Use what I call “Show Back” when teaching a patient to use a device or perform a particular task, to demonstrate correct use.
- Hand your patient written material upside down while discussing it, and observe whether they turn it right side up.
- Use simple language. Avoid complicated medical terminology or jargon. Use common, simple words to be as clear as possible and minimize the risk of misunderstanding. For example:
Speak more slowly when providing instructions. Be respectful and clear without being patronizing.Use graphics and pictures instead of long written instructions.Provide information at an appropriate grade level.
- Say “swallow” instead of “take”
- Say “harmful” instead of “adverse”
- Say “fats” instead of “lipids”
- Say “belly” instead of “abdomen”
- Say “lasting a short time, but often causing a serious problem” instead of “acute”
As we continue to work on improving the safety and reliability of care, we must expand our efforts beyond the standardization and simplification we focus on in the acute care and ambulatory settings. We must consider the other defects that contribute to patient harm, including how we communicate with patients about their treatment plans and their health. Ensuring that we are communicating clearly and delivering information at the appropriate literacy level will be an important step.
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