Let's face it. For the vast majority of people, it takes courage to speak up and admit a lack of clarity or understanding when encountering new information. It's certainly no different for patients. In healthcare settings, the gap between communication and understanding is compounded by a complex medical system and lack of appropriate tools to support both education and comprehension of health information.
Billions of dollars of unavoidable health costs can be attributed to limited health literacy each year. A report from the Institute of Medicine (IOM) points to an alarming rate of limited health literacy among American adults: Nearly half (90 million people) have limited understanding of written health information. The report also notes a higher rate of hospitalization and use of emergency services among these patients.
Health literacy is defined by the IOM as "the degree to which patients have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions." One way to raise the bar on the capacity for health literacy would be to equip healthcare providers with written, culturally and linguistically appropriate instructions to review with patients.
Patients often rely on electronically generated written education materials, and careful review of these materials with healthcare providers can facilitate discussions about diseases, procedures, treatments and home care. While the industry is limited in its ability to effect change on the people who enter the care system, it can work to ensure that clinicians are equipped to educate patients and that the teaching resources provided are clearly understandable by patients and caregivers.
Barriers to Effective Patient Education
Today's healthcare environments are characterized by leaner budgets and limited staff resources. Everyone is expected to do more with less. While no one would dispute the need for some belt tightening, the reality is that education sometimes takes a back seat to the pressing needs of the moment. Today clinicians are pulled in a variety of directions to cover everything from medication adjustments and preventing adverse events to helping indigent patients obtain the medications they need. They may view patient education as one more thing on their to-do list, rather than part of everything they do.
Research suggests that a wide communication gap exists between providers and patients when it comes to basic medical terminology and the value proposition of the information presented. The industry language that comes naturally to a clinician often seems foreign to patients, and human nature only exacerbates the situation by lending to an unwillingness of the patient to ask appropriate questions or appear unknowledgeable.
In terms of the value proposition, a communication gap often exists between the information a clinician deems important to relay and the information a patient wants to know. While critical information needs to be presented, it's important to establish a partnership of mutual, shared goals in care.
For example, if a patient is diagnosed with diabetes, a clinician likely wants to educate about controlling blood sugar levels through medications and proper diet. The patient may want to better understand how to incorporate his or her favorite foods into a diet that he or she fears will be very restrictive.
Recognizing the need to address patient education, hospitals across the country are taking action to ensure ownership of this critical aspect of patient care. Clinicians are either being designated with responsibility for this area or groups of clinicians or committees are being formed to develop protocols. Training in effective education techniques is also being provided with emphasis on "teach-back methods" to ensure patient comprehension is achieved.
The critical next step is to arm clinicians with the most effective tools for addressing limited health literacy. Information covering the broad scope of potential issues must be addressed with patients in a meaningful and straightforward way. To meet this need, electronic education materials must be enhanced to address specific needs outlined in current national initiatives.
Advancing Electronic Reference Tools to Improve Patient Education
Recognizing the current challenge, the National Action Plan to Improve Health Literacy has outlined seven goals to improve health literacy. These goals combine strategies for improving delivery of patient education with collaborative local and state efforts to promote better education about and knowledge of today's critical healthcare issues.
One of the primary goals outlined is the need to develop and deliver health and safety information that is accurate, accessible and actionable. In today's market, hospitals acquire their electronic reference and education materials from a variety of sources. But not all applications are equal in their ability to address limited health literacy.
To properly disseminate materials that are actionable, the information must be easily understood by all patients with limited health literacy. This aspect of diversity encompasses people of all ages, races, incomes and education levels. Even highly educated people appreciate clear and simple directions when under significant stress from illness or injury.
Industry recommendations point to the need for simple sentence structures written between a 5th and 7th grade reading level. Most materials on the market are written at higher levels. Bulleted, short statements are more effective than long paragraphs, and electronic reference applications need to allow options for printing in larger fonts for the vision impaired.
Because not everyone responds well to the written word - even if they have high-level reading skills - the use of simple, age- and audience-appropriate illustrations should be an important consideration. Drawings that are action-oriented or tell a story can confirm or reinforce the message relayed through the written word.
The provision of language support through the availability of pamphlets translated into various languages is also critical to the presentation and is expected to remain a focal point of national regulatory discussions in the future. The National Standards on Culturally and Linguistically Appropriate Services states that "healthcare organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service areas."
Going forward, healthcare organizations need to consider effective strategies for addressing limited health literacy as a means of enhancing patient safety and outcomes, as well as delivering more cost-efficient healthcare. It's one more step towards empowering patients in their care and reducing the revolving door effect in healthcare. Simply put, the best positioned hospitals will have applications that support the strategies outlined by the National Action Plan, including clear, concise printed education materials available in a wide variety of languages.
Kimberly Hume is a nurse who is the patient education coordinator for Wolters Kluwer Health. Elizabeth Tomsik is a pharmacist who is the adverse drug reaction manager at Wolters Kluwer Health.