Prioritizing Health Literacy Education

by Bria T. Lewis, Pharm.D, MPH, PGY-1 Community Pharmacy Resident, University of Mississippi School of Pharmacy

Effective communication is an essential skill for healthcare workers. Communication between healthcare professionals and patients is multifaceted and can become complicated by reduced or poor health literacy skills. According to the U.S. Department of Health and Human Services, health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.”¹ Unlike general literacy, health literacy focuses on specific skills needed to traverse the health care system and enables clear communication between healthcare providers and patients.

Improving health literacy education for health professionals is an essential concept of the U.S. National Action Plan to Improve Health Literacy. This concept must be prioritized by all health professionals who communicate with patients, and, just as importantly, those who educate emerging health professionals. It is important that health professions educators teach ways to both assess health literacy and to strategies to communicate to patients with low health literacy. Educators must take responsibility by recognizing the importance of effectively communicating health information to patients and work to address any deficits that may impede a patient from making the best decisions.² To mitigate such deficits, educators of health professionals must teach students about the common barriers that patients experience including a lack of understanding about disease states, local health guidelines, and the interpretation of test results³. 

While there are currently no widely accepted guidelines on health literacy education for healthcare professionals, healthcare educators should focus the scope of instruction on the following key skills:

1. Identifying Patients with Low Health Literacy: Healthcare professionals may not be able to identify patients with low health literacy. Factors associated with sufficient health literacy levels include higher individual income, advanced education, and greater professional success. In contrast, older adults, minority, or low-income populations are at risk for insufficient health literacy. Low health literacy has been shown to correlate with an increased risk of death and emergency room visits followed by hospitalization.

2. Use of Plain Language: Using non-medical language can enhance understanding between the patient and the provider. Students and health professionals may need to develop alternative language to explain concepts instead of using their acquired medical terminology.  Indeed, many patients, especially those of underserved populations, may not have literacy competency above a 5th-grade level. Thus, curriculums must include teaching students how to simplify complex words and concepts into 5th-grade English terms. This can be achieved by referencing medical terms that may appear during lectures in both the form understood by the medical community and the form understood by the average citizen. 

3. Focus the Message: Limiting the information to focus on one to three key messages is crucial. Focusing the key messages on behavior modifications will help empower and motivate patients. Educators should emphasize lessons that teach students and healthcare professionals to develop short explanations for common treatments and disease states which motivate action.

4. Importance of the Teach-Back method: Reviewing and repeating key information at the end of each visit will help with reinforcement. The ‘Teach Back” method serves as an effective tool to assess understanding and increase retention of information. Educators should introduce and use this tool throughout the curriculum in a fashion that requires students to “Teach Back” health information in laymen’s terms. This can be done by establishing simulation counseling sessions where students are required to translate medical information without using jargon.

Fortunately, there are several readily accessible health literacy education resources that educators can use. The Agency for Healthcare Research and Quality (AHRQ) has developed the Health Literacy Universal Precautions Approach to health literacy. This approach supports simplifying communication and reducing the complexity of healthcare. The toolkit offers twenty-one tools for improving health literacy by addressing spoken communication, written communication, and supportive systems. This guide is available for download at: AHRQ Health Literacy Universal Precautions Toolkit.  The CDC Clear Communication Index is a tool used to develop and assess public communication materials to determine if a message or material will likely match the health literacy skills of your intended audience.

Health literacy affects the health status of patients. Health literacy is a national concern. To provide the best care to our patients, all health professionals need to learn the key concepts and how to communicate complex ideas to patients using simple, clear language. 

References:

1. Health Literacy. Official Web Site of the U.S. Health Resources & Services Administration.” HRSA.gov, 31 Mar. 2017. Accessed 17 June 2021.
2. Bowen D. 5 How To’s for Teaching Health Literacy. Paeaonline.org. Accessed 17 June 2021.
3. Health Literacy. National Library of Medicine. NLM.gov, 2010. Accessed 17 June 2021.