Contributor: Laurie Myers, WG'99
To learn more about Laurie, click here
Regardless of your role in healthcare today, health literacy matters. If you attended Wharton, you have already proven your ability to understand extremely complex information about health and healthcare. There is, however, a more important question: how well can you communicate health information in a simple way to those looking to you for advice? This matters whether you are a physician communicating directly with a newly diagnosed patient; a marketer talking about your medicine; or a son or daughter, caring for an elderly parent.
The most widely cited definition of health literacy focuses on a person’s own ability to obtain, communicate, understand, and use basic health information and services to make appropriate health decisions. However, our healthcare system is very complex and difficult to navigate, even for those of us within the 12% of Americans with proficient health literacy. For instance, when my daughter was 8, she had surgery to remove a birthmark on her leg. The discharge nurse told me to limit her activity. My children are extremely active; so I interpreted this as “no travel sports for a few days.” I walked her around the Crayola Children’s Museum the next day, as a treat to make up for missing her Valentine’s party at school. Her leg started to bleed, and she needed another surgery to repair the wound. “Limit activity” is a very simple phrase; my health literacy is proficient; and I messed up badly. I am certain that every person reading this article has a similar story.
Health literacy has a profound impact on health. Health literacy is a stronger predictor of a person’s health status than age, income, employment status, and race. Low levels of health literacy may span all age, gender, education and/or income groups. Poor health literacy has a strong effect on both behavior and health outcomes, including:
- Preventive services - People with low health literacy tend to make less use of preventive care and screenings, such as mammograms and flu shots; and tend to enter the healthcare system later when their symptoms and/or disease is more advanced.
- Knowledge and Treatment – People with low health literacy tend to have less knowledge of their chronic conditions and of their optimal management; and are less likely to ask questions of their provider.
- Utilization – People with low health literacy generally have more hospital admissions that were potentially preventable, as well as more Emergency Department visits.
- Adherence – People with low health literacy often do not understand why they need to take medications; and do not often discuss difficulty affording medications during their interactions with physicians.
Why does this matter to you? Because of the complexity of the healthcare system, regardless of your role, you have the opportunity to help others understand. How can you do this? Use universal health literacy precautions: assume that everyone will benefit from simple and clear communication. Health literacy isn’t just about literacy, or only using materials written at a 6th grade reading level. You also must prioritize and limit key information. Trying to tell a newly diagnosed patient everything they need to know is not only inefficient, it doesn’t work. At most, people remember 3 key messages. When people are anxious, sick, or distraught, they may hear and remember very little of what you say.
Meet a person where they are, and confirm understanding using teach-back. A person manages most of his or her health at home, not in a doctor’s office or pharmacy. A person needs to understand what to do, or who to call when they have questions. Use of the teach-back technique is a great way to make sure that people are clear. The teach-back method shifts the emphasis to provider communication. For instance, a doctor can say, “I just want to make sure I was clear in telling you about your diabetes. What are you going to go home and tell your husband?” If a patient cannot repeat the key message or messages, the provider accepts responsibility. “Let’s try it again a different way.” Then again confirm understanding. This method also helps to overcome cultural norms that may inhibit a patient from asking questions.
This may sound easy – but often it is much harder to write and speak clearly than to use the language that we learned in school. Fortunately, the field of health literacy offers many free resources to help you.
1) If you are creating or using patient education materials, insist they follow health literacy principles. Dr. Ruth Parker and Kara Jacobson from Emory University have created a simple 2-page checklist, available at http://centerforhealthguidance.org/health-literacy-principles-checklist.pdf
2) The CDC has extensive health literacy resources available, including free online training, at http://www.cdc.gov/healthliteracy/
3) Merck has worked with Dr. Ruth Parker to create a video illustrating the use of the teach-back technique to help patients understand http://mediaus.epublishmerck.com/common/The_Teach_Back_Technique/index.html
Change takes time, but it is necessary to achieve patient empowerment. I have had the privilege of leading global health literacy strategy for Merck for the past 5 years. Our company has grown to understand that health literacy is not just relevant to written materials about disease, but also to developing clear patient labeling for new medicines; helping improve the participation of under-represented populations in clinical trials; and designing packaging to reduce medication errors. We are much further ahead in some areas than others; but understanding what is possible is the first step in progress.
Good luck in your own journey to clear communication!
Contact Laurie at: [email protected]