Health Literacy: My New Mission

by Lorien E. Menhennett

In my last blog post, I wrote, in general terms, about the freelance work I am doing for Joint Commission Resources. I mentioned that not only am I getting paid, I feel that I am getting paid to learn. In this post, I want to share some of the things I have been learning.

One of the projects I am working on is continuing education PowerPoint presentations for nurses. My role is to write quiz questions (which is really fun, but challenging as well), develop new lesson objectives, and adapt the lessons as needed to meet updated Joint Commission standards. Which, of course, requires me to closely read (scrutinize, really) every single slide of every single lesson. Originally I thought this task would be tedious and boring. On the contrary. I have learned some very interesting things about health care, things that I honestly am interested in incorporating into my future career as a physician-scientist.

The lessons I have been working on lately have dealt with health literacy and patient communication. As a Spanish medical translator, I know how critical it is to have trained translators, and to ensure that medical information is presented in a manner that every patient can understand. Quite often that means that the physician needs to tailor his or her explanations and demonstrations to a person’s level of education, for example.

But the concept of “health literacy,” at least in those specific terms, was new to me. The definition of “health literacy” on the U.S. Department of Health and Human Services Health Resources and Services Administration‘s Web site is:

“The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”

OK. We all know that doctors sometimes present complex information that doesn’t seem to make much sense unless you’ve been to medical school. But even basic health information isn’t so basic if you don’t speak English, don’t read, or have some cognitive impairment, for example. Or if you are under stress (which happens a lot if you are sick!). That’s where it becomes necessary for health care practitioners to engage with patients in a way that the patients can understand what is going on. That might mean using a translator (which is what I do), using visual aids, or other methods. There are many tools and strategies that I didn’t know about – tools I found very interesting, and potentially useful for me in the future.

AskMe3-logo-NPSF-notag_160pxOne of those strategies is called Ask Me 3™, a campaign developed by the National Patient Safety Foundation. This is what the NPSF’s Web site says about the program:

“Ask Me 3™ is a patient education program designed to promote communication between health care providers and patients in order to improve health outcomes. The program encourages patients to understand the answers to three questions:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Patients should be encouraged to ask their providers these three simple but essential questions in every health care interaction. Likewise, providers should always encourage their patients to understand the answers to these three questions.

Studies show that people who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure. They may also get well sooner or be able to better manage a chronic health condition.”

Encouraging patients to focus on these three basic – but key – questions engages patients in their care in a way that strips things down, removes some of the unnecessary complexity, from the situation and hopefully empowers them to make those “appropriate health decisions.”

On the Ask Me 3™ Web site, there are also links to resources to help in other ways. One way in which patient encounters can get out of hand – from a complexity standpoint – is through word choice. So the NPSF has a PDF document entitled Words To Watch (in both English and Spanish) which lists difficult words – and then simpler, but appropriate, alternatives. For example, rather than ask whether someone’s pain is “intermittent,” you could ask whether the pain is “off and on.” Definitely something to think about as I venture into the health care field myself, eventually.

But this information is not just for my future. As a Spanish medical translator, I hope to bring some of these tools and techniques into the free clinic where I work. Because really, nearly, if not all, the patient population at the clinic has low health literacy. And that can reduce the effectiveness of medical intervention.

But it is not only “LEP” – limited English proficiency – patients who struggle with health literacy. It is important to remember that there are many groups of people who are at risk for low health literacy, and also that even people who have high incomes and are educated can have low health literacy. In other words, health literacy can be an issue for anyone.

Here are some interesting, perhaps frightening, statistics about health literacy from the NPSF:

  • The health of 90 million people in the U.S. may be at risk because of the difficulty some patients experience in understanding and acting upon health information.
  • Literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, education level, or racial/ethnic group.
  • One out of five American adults reads at the 5th grade level or below, and the average American reads at the 8th to 9th grade level, yet most health care materials are written above the 10th grade level.
  • Limited health literacy increases the disparity in health care access among exceptionally vulnerable populations (such as racial/ethnic minorities and the elderly).
  • According to the Center for Health Care Strategies, a disproportionate number of minorities and immigrants are estimated to have literacy problems:
    • 50% of Hispanics
    • 40% of Blacks
    • 33% of Asians
  • More than 66% of US adults age 60 and over have either inadequate or marginal literacy skills.

I don’t want my patients to ever leave the exam room not fully understanding the answers to the three questions that the Ask Me 3™ campaign promotes. And knowing that now, before I even get into medical school, is pretty amazing. Like I said, I’m getting paid to learn. It’s a pretty sweet deal, if you ask me.