Help your patient “get” what you just said: A health literacy guide

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Applied Evidence

Help your patient “get” what you just said: A health literacy guide

J Fam Pract. 2012 April;61(4):190-196

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References

1. Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.

2. Kutner M, Greenburg E, Jin Y. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: National Center for Education Statistics; 2006.

3. Vernon JA, Trujillo A, Rosenbaum S, et al. Low health literacy: implications for national health policy. National Patient Safety Foundation; 2007. Available at: http://www.npsf.org/askme3/pdfs/Case_Report_10_07.pdf. Accessed March 21, 2011.

4. Schillinger D, Machtinger EL, Wang F, et al. Language, literacy, and communication regarding medication in an anticoagulation clinic: a comparison of verbal vs. visual assessment. J Health Commun. 2006;11:651-664.

5. Adams RJ, Appleton SL, Hill CL, et al. Inadequate health literacy is associated with increased asthma morbidity in a population sample. J Allergy Clin Immunol. 2009;124:601-602.

6. Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83-90.

7. Herndon JB, Chaney M, Carden D. Health literacy and emergency department outcomes: a systematic review. Ann Emerg Med. 2011;57:334-345.

8. Kirsch I, Jungeblut A, Jenkins L, et al. Adult Literacy in America: A First Look at the Findings of the National Adult Literacy Survey. 3rd ed. Washington, DC: National Center for Education, US Department of Education; 2002:201.

9. Davis T, Crouch M, Wills G, et al. The gap between patient reading and comprehension and the readability of patient education materials. J Fam Pract. 1990;31:533-538.

10. Brach CP, Cheyarley FM. Research findings #28: Demographics and health care access and utilization of limited-English-proficient and English-proficient Hispanics. 2008. Agency for Healthcare Research and Quality. Available at: http://www.meps.ahrq.gov/mepsweb/data_files/publications/rf28/rf28.pdf. Accessed May 20, 2011.

11. Ngo-Metzger Q, Telfair J, Sorkin DH, et al. Cultural Competency and Quality of Care: Obtaining the Patient’s Perspective. New York, NY: The Commonwealth Fund; 2006:963.

12. Bass PF, Wilson JF, Griffith CH, et al. Residents’ ability to identify patients with poor literacy skills. Acad Med. 2002;77:1039-1041.

13. Schwartzberg JG, Van Geest JB, Wang CC. eds. Understanding Health Literacy: Implications for Medicine and Public Health. Chicago, Ill: American Medical Association Press; 2005.

14. Kripalani S, Henderson LE, Chiu EY, et al. Predictors of medication self-management skill in a low-literacy population. J Gen Intern Med. 2006;21:852-856.

15. US Department of Health and Human Services. National Healthcare Disparities Report. 2010. Available at: http//www.ahrq.gov/qual/nhdr10/nhdr10.pdf. Accessed March 9, 2011.

16. Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36:588-594.

17. Davis TC, Long SW, Jackson RH, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391-395.

18. Parker RM, Baker DW, Williams MV, et al. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med. 1995;10:537-541.

19. Baker DW, Williams MV, Parker RM, et al. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38:33-42.

20. Shah LC, West P, Bremmeyr K, et al. Health literacy instrument in family medicine: the “Newest Vital Sign” ease of use and correlates. J Am Board Fam Med. 2010;23:195-203.

21. Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the Newest Vital Sign. Ann Fam Med. 2005;3:514-522.

22. Welch VL, VanGeest JB, Caskey R. Time, costs, and clinical utilization of screening for health literacy: a case study using the Newest Vital Sign (NVS) instrument. J Am Board Fam Med. 2011;24:281-289.

23. DeWalt DA, Callahan LF, Hawk VH, et al. Health Literacy Universal Precautions Toolkit. Rockville, MD: Agency for Healthcare Research and Quality; April 2010. 10-0046-EF. Available at: http://www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf. Accessed March 21, 2011.

24. Kessels RP. Patients’ memory for medical information. J R Soc Med. 2003;96:219-222.

25. Shillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83-90.

26. Wolf M, Bailey S, You W, et al. Improving patient understanding of preeclampsia, a randomized controlled trial. Am J Obstet Gynecol. 2011;206(suppl 1):S312.-

27. Kripalani S, Robertson R, Love-Ghaffari MH, et al. Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Educ Couns. 2007;66:368-377.

28. Clancy DE, Huang P, Okonofua E, et al. Group visits: promoting adherence to diabetes guidelines. J Gen Intern Med. 2007;22:620-624.

29. McLean S, Chandler D, Nurmatov U, et al. Telehealthcare for asthma. Cochrane Database Syst Rev. 2011;(1):CD007717.-

30. Liang X, Wang Q, Yang X, et al. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med. 2011;28:455-463.

31. Vale MJ, Jelinek MV, Best JD, et al. Coaching patients on achieving cardiovascular health (COACH): a multicenter randomized trial in patients with coronary heart disease. Arch Intern Med. 2003;163:2775-2783.

32. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48:923-933.

Table 3
Tips for helping patients with limited health literacy^23-30

Strategy	Key points
Warmly greet each patient	Maintain eye contact when you greet patients and during the interaction to encourage questions and disclosure
Use plain language (eg, high blood pressure rather than hypertension; liver instead of hepatic; heart attack, not myocardial infarction) and nonmedical terms, and speak clearly and at a moderate pace	Notice what words your patients use to describe a symptom or condition, and use those words throughout the interaction
Limit content	Prioritize what needs to be discussed, and present no more than 3 to 5 key points
Use visual aids	Draw simple pictures, use illustrations, demonstrate with 3-D models, or show videos that use nonmedical terms (adapted, as needed, for patients with LEP)
Provide encouragement	Encourage patients to ask questions about their health and treatment plans and to take an active role in managing their own health care
Assess recall and comprehension	Be specific and concrete, and repeat key points; confirm understanding by using “teach back”—asking patients to explain to you the information you provided to them
Take steps to provide additional patient support	Promote adherence and self-management skills by: instituting group visits implementing telephone/online coaching, reminders, or monitoring linking patients, as needed, to one or more members of an interdisciplinary health care team
LEP, limited English proficiency.

Take advantage of telemedicine … Health care delivered by telephone, Internet, video conference, or any other remote network may also be helpful. A Cochrane review found that patients with asthma who were the recipients of such interventions had a significant reduction in hospitalizations, particularly among those with more severe asthma.²⁹ A systematic review found that for patients with diabetes, mobile phone interventions were associated with a statistically significant improvement in glycemic control and self-management.³⁰

… and other providers. Interdisciplinary care has also been found to have a positive effect on management of chronic disease. One study found that patients with diabetes who received telephone coaching by nurses or nutritionists achieved a greater reduction in cholesterol and adherence to lipid-lowering medications than those who received the usual care.³¹ Direct patient care provided by pharmacists has also been associated with increased medication adherence and improvements in blood pressure, cholesterol levels, and HbA1c levels.³²

CORRESPONDENCE Michelle A. Roett, MD, MPH, FAAFP, Fort Lincoln Family Medicine Center, 4151 Bladensburg Road, Colmar Manor, MD 20722; mar2@georgetown.edu