Health Literacy and its Role in Patient Care

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When Lauren Phillips meets with one of her clients, a number of her services are often called upon. She might be helping process a green card, filling out paperwork, translating information or assisting an individual who is trying to set up a doctor’s appointment.

Phillips is a Refugee Social Services Program Manager and Job Coach with the American Civic Association (ACA) in Binghamton, NY. She meets with people every day for whom English is their secKey factors contributing to low health literacyond language. most of the people that seek her assistance are refugees whom the agency is helping to resettle. As they are adjusting to many aspects of their new life in the United States, one critical barrier they face is taking care of their health.

Low health literacy has significantly resulted in poor health and higher costs for care in our health care system. According to Say Ah, a New York based nonprofit dedicated to improving health literacy, individuals who are most negatively impacted by poor health literacy are less likely to take advantage of medical screenings and preventative health services.

The ACA stresses that the challenges individuals face is not just about language or socioeconomic status. Phillips and her colleagues spend time with their clients, listening to their concerns and learning about cultural differences that might prevent them from asking questions at doctor’s appointments. “It’s really important for healthcare providers to understand that cultural competency is constantly changing and their patients are continually reevaluating and adapting,” she shared. “They just want to know that they are respected nd being heard.”

In order to help with this, staff and volunteers from ACA accompany their clients to health care appointments. Sometimes they serve as translators, but most often, they are the patients’ advocates, encouraging them to ask questions and helping to make sure they are understanding the information they are receiving from the healthcare professional. Sometimes, something as simple as understanding how and when to take medication is made clearer with the help of an advocate.

One exercise that can help improve health literacy during an appointment is the “Teach Back Method”. Teach Back is an exercise where the provider asks the patient to repeat what they just said to them. In the case of taking medication, for example, the patient would reiterate to the provider what was just explained, to be certain that the patient has a strong understanding of the prescribed instructions. Similarly, providers are encouraged to repeat the concerns that the patients bring to the appointment in order to give their patients the confidence in knowing that they have been heard. This reflective listening skill is used with Motivational Interviewing which is another technique healthcare professionals are encouraged to use to enhance patient experience.

Workshops are being offered in the region to help future healthcare professionals and patients improve health literacy. A recent needs assessment of a 17-county service area indicated that health literacy is one of the top 10 training opportunities. One of the populations most greatly impacted by poor health literacy are people over the age of 65. Karen Brown is the Program Coordinator for the Finger Lakes Geriatric Education Center at Ithaca College (FLGEC). In her role, Brown provides training for patients, families, caregivers, direct care workers, health professional providers, students, residents, fellows, and faculty in these counties representing rural communities.

Brown comes from a family of nurses who use medical terminology in everyday conversations. She often reminds them that they don’t use plain language. In her pervious work, as a case manager, she witnessed first-hand the frustration patients felt when they were confused and overwhelmed with new medical information. “I saw the difference in my clients’ health outcomes when they were engaged and informed,” Brown shared. “I want to help the future medical workforce be better prepared for working with elderly populations and give them strategies to achieve positive results for their patients.”

Karen Pantel is an online adjunct nursing instructor at Excelsior College. She teaches and facilitates a course focused on Community Health Nursing. Her students are Registered Nurses from across the country. Pantel heard about the workshop series at FLGEC and jumped on the opportunity to attend. “I saw this as a perfect fit to enhance my health literacy teaching tool kit,” Pantel explained.

Already well versed in health literacy and having created curriculum focused on patient and staff health literacy assessments, Panel walked away from the workshop series with some very valuable insights and heightened enthusiasm. She explained that the information will help her continue to build upon the training she provides to her students. Additionally, she plans to apply what she’s learned to her involvement in older adult communities as well as in her professional associations. “The knowledge and creative presentation tools I’ve gained from these workshops make me intent on researching the role of health literacy in improving patient outcomes,” she shared.

Currently, FLGEC offers Health Literacy modules: Plain Language, Teach Back Method, Health Literacy 101, Health Numeracy, Communicating Effectively with your Healthcare Provider, and Finding Accurate and Reliable Information on the web. The workshops focus on defining the key concepts of Health Literacy, implications of low health literacy on patient understanding, health outcomes and medical costs, and identifying strategies and techniques to increase clear communication and patient understanding. These workshops are open to the community and are held several times throughout the year.

Both Brown and Phillips are members of Care Compass Networks’ Cultural Competency and Health Literacy (CCHL) workgroup. The workgroup brings professionals from various organizations and disciplines together to address obstacles related to Cultural Competency and Health Literacy. Their goal is to focus on the barriers that contribute to poor health literacy which results in avoidable hospitalizations. The workgroup is in the process of implementing a survey focused on Patient Experience. The goals is to uncover the areas where there are strengths and weaknesses in providers’ ability to influence health literacy for their patients. The results of this survey will help CCN and our partner organizations further create comprehensive training programs that cover Cultural Competency and Health Literacy.