Healthcare Workers Responsible for Patients' Health Literacy

Laurie Barclay, MD

April 21, 2011

April 21, 2011 — Responsibility for recognizing and addressing the problem of limited health literacy lies with all healthcare professionals, according to a Committee Opinion of the American College of Obstetricians and Gynecologists (ACOG) published in the May issue of Obstetrics & Gynecology. Two related Committee Opinions in the same issue discuss the impact of communications skills and strategies and cultural sensitivity issues on patient-physician communication.

"The problem of health illiteracy is widespread and goes beyond those who can’t read or those who don't speak English," said Patrice M. Weiss, MD, chair of the ACOG Committee on Patient Safety and Quality Improvement, in a news release. "Physicians, nurses, social workers — everyone in the health care field — must make sure that our patients fully understand their health condition and their treatment, as well as the importance of taking their medications exactly as directed. We simply can't assume that a patient understands because she nods her head or because we think she seems educated."

The Institute of Medicine of the National Academies defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is limited in nearly half of all people in the United States, resulting in a higher risk for hospitalization, more barriers to getting necessary healthcare, and poor comprehension of medical advice causing morbidity and even mortality.

As part of its commitment to promoting health literacy for all patients, ACOG supports the following recommendations, which were adapted from the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion's Quick Guide to Health Literacy:

  • Tailor speaking and listening skills to individual patients. Use open-ended questions starting with the words "what" or "how," and use medically trained interpreters when needed. Especially during the informed-consent process, but also in general, check patients' comprehension by having them restate the health information given in their own words. Encourage staff and colleagues to use culturally sensitive plain language to obtain training in improving patient communication.

  • Tailor health information to the intended user by ensuring that it reflects the target group's age, social and cultural diversity, language, and literacy skills. Include the target group in the development (pretest) and implementation (posttest) phases of developing information and services to improve effectiveness of the program. Consider cultural factors, including race, ethnicity, language, nationality, religion, age, sex, sexual orientation, income level, and occupation when preparing health information.

  • Develop written materials conveying no more than 4 simple messages per handout. These materials should focus on action and give specific recommendations based on behavior rather than on the underlying medical principle. Use the active voice instead of the passive voice, use familiar language, and avoid jargon. Use culturally relevant visual aids such as drawings or models for key points, use 12-point type size or larger, and leave sufficient white space around margins and between sections.

"Many patients are called 'noncompliant' because they haven't followed their doctor's recommendations, but this may be because they don't understand what is expected of them," Dr. Weiss said. "As physicians, we need to use less complex language with our patients when explaining their health conditions, surgeries, and taking medications. Asking our patients to repeat back to us what they understand is enormously helpful in making sure they really do comprehend."

Obstet Gynecol. 2011;117:1250-1253. Extract

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