With roughly 9 out of 10 Americans having a low health literacy level, can providers bridge the gap between literacy and outcomes?
by Lyndsey Lord
January 4, 2019

In our daily lives, we are constantly receiving directions. Whether it is a traffic light telling us to go, a sign telling us to be careful or a door telling us to push, there is a constant flow of information that indicates what we should and shouldn’t do to get where we want to go safely.

When providing health services, the same is true.

Health care providers deliver a myriad of directions designed to keep patients safe. Whereas the routine direction that we receive daily tends to be clear and concise, clinical care instructions and patient education tend to be filled with medical jargon that can be difficult to comprehend. This is why health literacy is critical.

Health literacy is defined as the degree to which individuals can obtain, process and understand necessary health information and services needed to make appropriate health decisions. With roughly 9 out of 10 Americans having a low health literacy level, it is important to take a closer look at how providers can help improve health literacy and understanding among patients.

Health Literacy and Patients in Home Health Care

For home health agencies, in particular, it is essential for visiting nurses to ensure that each patient understands their unique plan of care. Although patients should be educated about their care plan while at the hospital or after a doctor’s visit, it is not unusual that they forget key pieces of information once home. The patient may have received a multitude of information and instruction from different providers.

Even when all parties are aligned regarding the plan of care, minor variations in presenting the information may cause the patient to interpret the content or directions very differently. It becomes critical for visiting nurses, who may only be with the patient a few hours each week, to ensure repetition and reinforcement of care instructions during each visit.

Low health literacy levels can make it hard for a patient to follow a healthy diet, manage chronic diseases, monitor medications and understand educational materials regarding their health. Therefore, patients who do not fully comprehend their care instructions are more likely to have an adverse event, such as a readmission to the hospital. To combat this challenge, agencies can leverage a variety of strategies to minimize adverse events by addressing health literacy gaps and reinforcing complex, medical information.

1. Leverage the Teach-Back Method

If you ask a patient, “Do you understand your instructions?” after receiving a substantial amount of information, they will most likely reply, “Yes,” and not admit they need further explanation. Oftentimes, the information is so great that a patient believes they understand everything and only later realizes that they did not fully understand.

Teach-back is a powerful technique that can be used to ensure that patients truly comprehend. In this method, you are asking the patient to teach you, the care provider, the information that you gave them. It challenges the patient to state in his or her own words what they need to know regarding their health.

For example, as a nurse is leaving a patient’s home after a visit, instead of asking, “Do you understand your medications?” he or she should ask the patient, “Can you tell me about your medication regimen?”

The teach-back method helps caregivers confirm that they have explained relevant information in a manner in which the patient understands. When a patient has a clear understanding of the information provided, they are more likely to adhere to instructions, reducing the likelihood of complications.

2. Use Clinically Proven Technology

According to the 2013 Institute of Medicine report on health literacy, technology can play a critical factor in bridging the gap between literacy and outcomes. Technology has become an essential element in the health care continuum. Providers are implementing technology to make data-driven decisions, enhance the patient experience and increase engagement and satisfaction; some may not realize that technology can also help improve the health literacy of patients. A few approaches can be leveraged:

Automated Outreach

Many providers are leveraging automation to help ensure consistent messaging through outreach, providing multiple benefits to patients and providers. Phrasing education and follow-up questions in a similar manner from one call to the next helps patients understand the purpose and benefit of sharing this information with their care team. This helps to eliminate the confusion stemming from patients calling multiple providers for various questions.

If a patient is aware that they will receive automated outreach and that this is an avenue to share information and request help, if needed, they are more likely to use this tool to communicate questions, concerns and recovery updates. This also provides clinicians with additional information and data points prior to their visit.

For home health clinicians, leveraging information obtained between visits can help them better understand the patient’s needs and goals for the visit, so they can optimize time with each patient.

Recorded Care Instructions

Providers should consider recording individualized discharge instructions that patients and families can access as needed. They may also include recordings for specific clinical groups, such as congestive heart failure, or procedural groups, such as total knee replacement. Since everyone learns and recalls information differently, supplying a patient with both written and recorded instructions can increase comprehension.

Additionally, patients who struggle with reading may be embarrassed to share that they do not understand the written instructions. By adding a recording, those patients can listen as frequently as needed to ensure understanding. Also, clinical teams may be alerted of patients who frequently access their recordings
and may require additional support or reinforcement.

Digital Checklists

Another approach used by many providers is to leverage digital checklists to ensure that consistent topics are covered and reinforced for patients throughout their transition. This particular strategy can begin in the acute setting and be continued by post-acute providers. This ensures consistent messaging to patients.

Clinical-speak is a language that most patients are not fluent in, and minor deviations in the presentation of clinical information may be interpreted differently by the patient or family.

When providers collaborate on consistent ways to educate patients and articulate their care plan, they significantly increase the level of patient understanding. When patients genuinely understand their clinical needs and plan of care, they are more likely to be active participants on the road to recovery.

How Health Literacy Improves Agency Performance

Patient education plays an increasingly important role in health care. Patients are no longer viewed as consumers, but instead, acknowledged as partners. As beneficial as this new reality may be, it also poses challenges.

Since every patient is unique, providers need to take into consideration the various levels of education and literacy. One patient’s ability to comprehend complex clinical information will be different from another’s. When you ensure that your patients understand care instructions, you guide them on a path to successful recovery.

Enhancing health literacy not only educates patients but delivers quality care and improves engagement. This leads to happier patients, healthier patients, and improved quality and outcomes for your entire population.