Take two tablets by mouth twice daily.
Sounds simple enough, right? Of course it means to orally ingest with water two capsules, one around noon and one in the evening. In a study of patients with low health literacy, 71 percent responded that they understood. However, only 35 percent were able to demonstrate the directions they were given.
This is worrisome. Discipline and everyday forgetfulness are enough to cause patients to stray from their medication regimens, but poor health literacy compounds these issues exponentially. Furthermore, health literacy is a strong predictor of overall health, and studies indicate that those who are deemed illiterate often exhibit worse health outcomes, low utilization of preventive care, and report poor patient satisfaction and a higher hospital readmission rate.
Unfortunately, evidence suggests only 12 percent of American adults possess “adequate” health literacy.
But what exactly is health literacy?
The World Health Organization (WHO) defines health literacy as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health.”
Cognitive and social, that’s the key. On the cognitive side, low health literacy does not mean that a patient is unintelligent or incapable of grasping the ins and outs of their condition. Rather, the physician must tailor their words and presentation to fit the patient’s unique way of understanding information. As for the social aspect, health literacy occupies the intersection of many social determinants of health, those factors such as housing, employment, and transportation that are neither biological nor behavioral, yet account for 60 percent of health outcomes. In fact, health literacy has even been called the “newest vital sign.”
“Health literacy empowers patients to manage their health and well-being,” Meredith Josephs, MD, says. “A patient who has the ability to understand their diagnoses and treatment options is then able to fully engage with the provider as a partner in making ongoing decisions about care.” Notice the relation between health literacy and healthcare consumerism. Just as consumers need adequate information in order to be empowered, savvy, discerning consumers, patients with low or marginal health literacy require more information to guide their health decisions.
Another way to think of health literacy is as a condition that must be treated alongside a patient’s “actual” conditions. And it is. There’s no prescription you can write, nor even a miracle cure, that will help a patient if they are unclear on instructions and do not take it. Likewise, they’re more likely to consult you if they are confident they’ll receive clear, actionable information.
How to Conduct a Health Literacy Audit & Intervention
“The physician has a few different roles to play to promote health literacy. When working directly with patients it is important to convey medical information in terms that the patient can understand and absorb,” Dr. Josephs says. “Outside of the exam room, the physician should support the larger healthcare team in understanding the importance of health literacy. At times this means teaching others about diseases, conditions, medications, etc. Physicians also play a role in ensuring health education content in the office is at an appropriate level for the intended audience with regards to age, topics, language, culture, and other factors.”
Begin with yourself and your care team. According to Dr. Josephs, “The hectic pace of a physician’s office practice results in limited time with patients. Limited time translates into rushed conversations that often lack assessment of patient’s understanding of the content. The physician’s care team can support both the patient and the physician by working with the patient to ensure instructions are understood and all questions are answered.”
What does this look like? Ask yourself: Do you occasionally use the clinical term when a more digestible term would fit? Or perhaps a ten-cent word when a simpler one would do? For instance, consider using “belly” instead of “abdomen” or “in one place” instead of “localized.” Psychologist William James once said, “Truth is what works.” Apply this pragmatic view to your practice to get patients to do what is best for themselves. For help implementing these changes, consult the Centers for Disease Prevention and Control’s guide to “Everyday Words for Public Health Communication.”
Now that you’ve reassessed your language and front office staff, here are some tips to level up your engagement with your patients.
Some patients are inevitably more visual learners, while some are better listeners. The University of Michigan and Robert Wood Johnson Foundation’s VizHealth is one resource for the former. With their vibrant, simple, and crystal clear diagrams organized by level of detail, goals, health conditions, and data format, you can find a visual aid to help drive your point home and make it resonate with a patient. Plus, they can take it home with them in case they need to consult it in the future. For patients who prefer listening, encourage your patients to record the visit using an app on their phone so that they may replay it in case they are confused. Or, for patients who prefer or require a combination of visual and auditory inputs, consider videos; YouTube has a robust library of videos by companies like Osmosis, which illustrates and explains in everyday language topics such as electrocardiography, congestive heart failure, amnesia, and everything in between.
One of the most promising solutions is the teach-back method. “Frequently check for understanding by asking the patient to use their own words to describe what the treatment plan is,” Dr. Josephs advises. By explaining a diagnosis, treatment plan, or advice back to you, you can account for any gaps in their understanding. For an example, scroll back up to the top of this blog and notice the researchers’ methodology and what it reveals about the disparity between what patients say they understand versus their true comprehension.
Curious to learn more about social determinants of health? Visit our Topics page where you’ll find deep dives into the Loneliness Epidemic, obesity, and what hurricanes can teach you about your patient population.