5 How To’s for Teaching Health Literacy

PA educators stress to their students over and over again how important it is to educate their patients. I hear them parrot that back to us as they confront issues of behavior change and patient non-adherence to treatment plans. “The answer is to educate the patient on the importance of…”

Yet, although we know that good communication between a PA and their patient is a key to good health education, we may only pay lip service to the idea and do very little to teach our students how to effectively communicate.

A patient’s ability to read, understand, and apply health-related information plays a huge role in the effectiveness of both oral and written patient education. This concept of health literacy has been recognized as a primary contributor to health for many years.

In 2003, for the first time, the National Assessment of Adult Literacy (NAAL) measured health literacy among American adults. The results were eye opening. Only 65 percent of adults scored at an intermediate or proficient level of health literacy. Some 14 percent (30 million) of adults scored below the basic level, and another 22 percent (47 million) scored at only a basic level.

A systematic review of the literature in 2012 indicated that low health literacy is linked to worse health outcomes and decreased use of health care services. The authors of the review concluded that there was emerging evidence that lower health literacy could also partly explain the racial and ethnic disparities in health outcomes.

The NAAL survey in 2003 indicated that race, ethnicity, and socioeconomic status were risk factors for poor health literacy. Thirty-five percent of Hispanic adults, 19 percent of Black adults, and 43 percent of adults living below the poverty threshold scored at or below the basic level in health literacy as compared to 14 percent of all American adults participating in the survey. Secretary of Health and Human Services Sylvia Mathews Burwell said, “If we want health equity, we need to make health literacy a priority.”

Interventions that address low health literacy may help to reduce these disparities. Teaching your PA students about these strategies will help them to develop into providers who are able to communicate effectively with their patients, have better health outcomes, and maybe do their part in reducing health care disparities.

How can you make sure that your program is covering the bare essentials of teaching health literacy to students? The key points to cover in your curriculum are:

1. How to identify a patient with low health literacy

Health care providers are notoriously poor at identifying patients with low health literacy, and patients with reading problems don’t often disclose their illiteracy. Some signs that a patient may struggle with literacy include poor compliance with treatments and appointments, confusion about medication, and making excuses for not reading. A great way to check the health literacy skills of a patient is by doing a medication review. Ask the patient to explain the purpose of their medications and show you how they are using them.

 2. How to use plain language

Using plain, non-medical language can enhance understanding dramatically. Using the patient’s own terms for their illness and treatments is a good starting point. Students often need to be reminded of alternative language for their newly acquired medical terminology. For example: “pain-killer” instead of “analgesic,” “birth control” instead of “contraception.”

 3. How to focus the message

Less than half of the information provided during a typical medical encounter is retained by the patient, even if the patient is proficient in health literacy. Limiting the information by focusing on one to three key messages per visit is crucial. Patients who struggle with health literacy will respond more to information that is designed to promote action than to detailed explanations and facts. Focusing the key messages on behavior instead will help to motivate and empower the patient. Developing short explanations for common diagnosis and treatments will help the provider to avoid giving the patient a lecture on pathophysiology and pharmacology.

 4. How to use the Teach Back method

Reviewing and repeating each point at the end of each visit will help to reinforce the key messages. The “Teach Back” method is a powerful tool and should be taught to all health professions students. It is a test of how well the provider has explained the concept in a way that the patient understands. It provides an opportunity to check for understanding and if needed, to re-teach the information. It is important to use open-ended questions and avoid yes/no questions like, “Do you understand?” or “Do you have any questions?”

5. How to evaluate written materials

Using written materials to educate our patients can be an efficient way to help patients absorb new information. Unfortunately, they are often inappropriate or given to patients in lieu of providing educational counseling and end up in the waiting room trash can. Our students need to know how to assess the content and effectiveness of the materials they provide and how to review the information provided to the patient. Patient-friendly educational materials should be written at a 4th – 6th grade level and limited to no more than two messages at a time. The Flesch-Kincaid Grade Level and Flesch Reading Ease Score are simple tools for testing readability.

Celebrate Health Literacy Month by taking a look at your program’s patient education curriculum and making sure that you are including these key points.