We can assess health literacy and practice skills to provide information to families to ensure they understand us. (See the related topic on helping families with Limited English proficiency)
Here are the materials for this week:
- Health Literacy Case and Discussion
- Health Literacy: The Gap Between Physicians and Patients, AFP 2005
- Arc of Health Literacy – Koh and Rudd, JAMA 2015
- Fun study using 9 year old children to design patient-education materials that are at an appropriate reading level
Take-home points on assessing and augmenting health literacy:
- How do we define “health literacy”? Health literacy is defined by the AMA as “the ability to perform basic reading and numerical tasks required to function in the health care environment.”
- How common is low health literacy? More than 1/3 of adults are considered to have basic or below basic health literacy, meaning they may struggle with understanding growth charts, immunization schedules or dosing medication. Many people read below the highest grade they completed, and most adults read at an 8th-9th grade level, while health care material is often written at a 10th grade level. While our knowledge base has exploded and there is more access than ever to information, as Dr. Koh writes in his commentary in JAMA (above), “The paradox is that people are awash in knowledge they may be unable to use.”
- What are ways to assess health literacy? We can assess health literacy using validated tools or, more practically, understanding risk factors: for pediatric caregivers these include not completing 12th grade, not living with the child’s other parent, and not reading for pleasure. These are all associated with 6th grade or below reading level.
- How should we approach low health literacy? A “universal precautions” approach is recommended, regardless of a person’s health literacy. This means we should explain things as clearly as we can to everyone using “living room language”. We can ask directly if they have a medical background, which can sometimes help us tailor our information; however, we still need to be careful about making assumptions of what people know/understand. A few examples illustrate this: my spouse, who has a non-medical doctorate and a better vocabulary than me, has to remind me when he does not know medical terminology during our conversations. Even parents who have medical careers but work with adults often will admit they do not feel comfortable or familiar with pediatric issues.
- What strategies have been shown to improve understanding? One of the best is the Teach-Back Method, asking parents/adolescents to repeat back the plan. Trainees sometimes worry this may sound condescending, but we can use it in a self-deprecating way: “I know this can be confusing, and I want to make sure I have explained things clearly. Would you mind repeating back what you heard so we can be sure it made sense to you?” Teach-back is associated with increased patient-centered communication in pediatric primary care. Another very effective approach is to use pictures. A review of articles that used pictures in medical teaching showed that patients recalled 1.5-2 times more information with pictures. A great way to do this in clinic is to draw on the exam table paper. I love using this as an opportunity to teach kids / parents more about how the human body works. Finally, use easy-to-read measuring tools for dosing medications, including clearly marked syringes that are close in size to the prescribed dosage.