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If you’re at a loss about how to communicate with your clients who may have health literacy issues, take a tip from elementary school teachers, Sue Binder, RN, CCM, suggests. "The principles of case management — assessment, treatment plan, and evaluation — are not too far away from the educator’s principles," says Binder, principal of Integrated Healthcare Consultants in Caldwell, NJ. The educator assesses the education and knowledge base. The clinical case manager assess the health status and knowledge base, she points out.
You might start with a pre-test to assess what clients already know. Make sure the test is simple so they can understand it, Binder says. If your clients can’t even read on a fourth-grade level, there are other ways of teaching them. If you find they aren’t able to comprehend written literature you’ve given them, use some other medium, such as symbols or pictures, she advises.
"People need to get information through a variety of different communication channels but most providers and most health plans think the old-fashioned way," asserts Scott Ratzan, MD, editor of the Journal of Health Communications and a member of the American Medical Association’s steering committee on health literacy. Ratzan suggests using the Internet, videos, CD-ROMs, audio cassettes, and, for people with low literacy, visual presentations that don’t even have words, such as picture demonstrations.
After the clients have seen your presentation or read the materials, ask them to repeat the information so you’ll know they understand it. "What is absolutely essential is feedback and validation from the learner," Binder says.
Here are some other ways to make sure your clients’ health literacy is up to snuff:
• Make an assessment of every client. Ask yourself if this patient is struggling with health literacy because of culture, illiteracy, or for other reasons.
• Make it a point to use language that your patients and their families can understand.
• Use visual and other cues to make sure patients understand the appropriate treatment plan and what they should do to follow up.
• Develop materials than don’t require high literacy to understand them. Remember that if patients can’t read, it doesn’t help to give them a brochure or information sheet.
• Ask your patients to show you or teach you back how they are supposed to take their medications, or what diet they should follow.
• If you find that some clients don’t understand what you are saying, develop strategies to deal with it. You could refer them to an adult literacy program. In the meantime, you could show them a video about their disease.
• Use teaching principles to help your clients understand what they are supposed to do. If you’re not certain of how to do it, talk to friends who are educators.