Patient Education and Health Literacy

by Jessie R. Lish, Pharm.D. - PGY2 Ambulatory Care Resident, Baltimore VA Medical Center

Educators are those who serve as learning facilitators, coaches, and guides to learners of all abilities and learning styles. No two learners are created equal, and no two educators teach in the exact same way. The unique teaching characteristics that educators possess are the reasons why they are able to teach courses and topics of all varieties. As an example, my father is a high school biology teacher, and my mother is a retired K-3 art teacher. My father teaches best through lecture in class with a little bit of laboratory work woven into his classes. My mother, on the other hand, taught mostly through hands-on art-making. For my father, using lecture and laboratory means to teach his classes was effective. In my mom’s art classes, younger children responded better to hands-on activities and would not have been well suited for a lecture-type of activity. The common theme in both examples is that educators portray information in ways best suited to their particular audience. As educators and pharmacists, we have to remember that even though we’re not in a formal classroom setting, our patients are learners and our “audience.” The same teaching principles hold true when we are educating and counseling our patients.

I recently read an article in Pharmacy Today (Ngoh LN. Health literacy: a barrier to pharmacist-patient communication and medication adherence. Pharmacy Today 2009;15(8):45-57.) – a publication of the American Pharmacists Association. The article is a review of existing literature regarding medication adherence, health literacy, and the use of written patient information in health care and pharmacy in particular. This article caught my attention because my PGY2 residency project is examining barriers to patient follow-up and monitoring in a psychiatric patient population taking second generation antipsychotic medications. After reading through the review article, I began to think that the patients we serve and educate everyday are kind of similar to our students that we teach in a more formal setting. Students come from a variety of backgrounds, learning styles, and interests. The same holds true for patients! Anyway, this article/review indicated that the health literacy skills of American adults have not changed considerably over the past decade. The author goes on to say that health literacy is a characteristic of a patient that may place him/her at higher likelihood of poor adherence to a medication regimen. I think about this everyday…how can we combat this and help educate our patients so that they truly learn about their health and the medications needed to control disease states?

I think it all comes back to a learner’s style of absorbing information presented to him/her. I relate this to Kolb’s learning styles. Kolb says that how we learn, or our “theory of learning,” is grounded in our experiences. He goes on to say that there are four styles through which learners glean information: 1) feeler; 2) doer; 3) watcher, and 4) thinker. Feelers learn best from specific examples in which they can be involved. Doers like to see everything and then determine their own criteria. Watchers learn best from demonstrations/lectures. Thinkers like to take new information and incorporate it into their own experiences. To relate this to our patients, a doer might be a patient who wants to see all medication options and then determine which one he/she would want to take depending upon the information presented. A watcher may be a patient who would benefit from listening to a short lecture on diabetes and how he/she can decrease his/her risk factors. A thinker may be a patient who would try a medication, think about how it made him/her feel, and then approach the health educator to discuss different options. A feeler may be a patient who takes the medication information home to read it on his/her own time and formulate his/her own opinion. No matter which learning style a patient possesses, he/she is going to benefit from a variety of teaching styles.

I believe that if we approach each patient with a fresh mindset, we can take into account our audience (i.e. the patient), the learning content (i.e. medication information/disease state information), the learning style of the patient (i.e. if the patient is a more hands-on learner and requires pictures; if the patient cannot read/understand English and requires a translator; if the patient prefers to read the information him/her self, etc.) and adapt our teaching style to fit that patient. From personal experience, I know that the patients I see in geriatrics clinic differ from my younger patients in the diabetes clinic, who differ from the patients I serve in the mental health clinic. I am constantly adapting my teaching and educating styles to fit whichever patient population I’m working with that day. I truly believe that all teachers and learners/patients are not created equal, and to truly benefit our patients, we must adapt to each situation.

[Editor's Commentary: Health literacy can significantly impact health outcomes and its an issue that every clinician should have a working knowledge about. Health literacy is NOT synonymous with literacy. While they are related concepts, patients can be literate - indeed, well educated - and have relatively poor HEALTH literacy. Clinicians often make assumptions about patients who are articulate and well educate. Some fully understand health terminology and complex health concepts. But many don't. That's why its so critically important to know your learners - to figure out what they already know, what they need to know, and how they learn best. S.H.]