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Tips to teaching patients with low health literacy
First, assess barriers
The first step to teaching patients who have low health literacy is to assess the barriers to their understanding medical instructions, an expert advises.
"Find out what the problem is and why they're not getting it," says Susan A. Rogers, RN-BC, BSN, CCM, president of Rogers Professional Guidance in Overland Park, KS. Rogers spoke about assessing health literacy at the 18th annual conference of the Case Management Society of America (CMSA), held June 17-20, 2008, in Orlando, FL.
Barriers could be language or cultural issues, she notes.
"Once you assess the problem, you can handle it," Rogers says.
For example, a discharge planner might use Pfizer's Newest Vital Sign tool to see if the patient can read a simple food nutrition label.
If the patient cannot understand the food label, then it's doubtful that the patient will understand written instructions about how and when to take complicated medication regimens and other health advice.
"So you'll need to keep the message simple," Rogers says. "Don't ask, 'Do you understand?' because the patient probably will say 'Yes,' and nod his head."
People don't like to admit when they don't understand something because it embarrasses them, Rogers says.
Another key to improving communications is to keep written material at the 4th or 5th grade reading level, which is about the same reading level as many popular novels, such as John Grisham thrillers.
"Two out of three people with low literacy hide this from their spouses even," Rogers notes.
Discharge planners also should assess each patient's learning style, Rogers suggests.
Patients who learn through listening to instructions could be given examples of medical instructions verbally and then be asked to repeat these, she says.
"For a seeing learner, you might play a videotape," Rogers says.
Visual learners also might benefit from brochures, if they're medically literate, or being steered toward educational Web sites, if they're technology-savvy, she adds.
Another strategy would be to show the patient a cardboard drawing of a clock and tape pills at the times when the patient will need to take his or her medication, she adds.
People who must experience something before they can truly understand it will need hands-on help.
For instance, a discharge planner could help them count out their pills and place these in a pillbox that's divided by days, Rogers says.
Those who learn through experience might return to the hospital, but this should be seen as an opportunity to make the discharge education stick, she says.
"Once they've experienced the problem, you can go back and show them another aspect of their health care," Rogers says.
Discharge planners also could ask patients how they could help them adhere to their medical regimen and appointments.
"You could say, 'You'll have to go back to your doctor, so what do I have to do to help you get back to that doctor?'" Rogers suggests. "Do I need to write it down for you or put it in your PDA?"
Another strategy is for discharge planners to have patients ask themselves these three questions:
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?
"These three questions will lead to answers they can use when they return home," Rogers says. "Discharge planners should teach patients to ask these questions; otherwise, we'll see them back in the door again."
These various teaching tactics are important even when patients have high health literacy, Rogers says.
"I'm a nurse, and I'm a visual learner, so if someone rattles off stuff to me, I pull back and might not hear it," Rogers explains. "So even though we may have high health literacy, we still have the ability to learn in a specific way."
For Rogers, a more effective teaching style would involve a chart or chalkboard diagram, she notes.
"We need to pay attention to the patient, so while we're chatting with patients we can hear what they're saying back to us and we can figure out where they are," Rogers explains.
"If you're lecturing, and the patient is staring at walls, and if you ask him to teach it back and he can't come up with anything, then this patient probably is not a listener," Rogers says.
It would be time to switch tactics and use visual learning material, she adds.
"The point of all health literacy theory is to find out what the individual is all about," Rogers says.