Education Nation: Five Tips for Boosting Healthcare Literacy
Following doctor’s orders, the elderly Bronx man went in for a round of blood tests. Yet he didn’t know what his doctor was looking for, or even which of his chronic conditions the tests sought to address. This lack of communication, understanding and education is all too common and it points out the need for better health literacy, one of the most valuable currencies in our new and ever-changing healthcare landscape.
As the focus of health care increasingly shifts from acute, episodic care delivery to wellness management for chronic conditions, patients and family members are becoming important partners on their own healthcare teams. This means they need to understand and comply with medication regimens and specialized diets, and be able to regularly assess and manage vital measures such as weight, sugars and blood pressure (BP). Healthcare literacy involves understanding the daily ins and outs of living with chronic conditions, being fluent in the markers of the illnesses or conditions being treated, and knowing what to do when sudden weight gains, BP spikes or sugar fluctuations occur — which might include continuing to monitor the symptoms, checking with the doctor, or even calling 911.
According to the Center for Health Care Strategies (CHSC), some 90 million Americans have low health literacy. While this issue encompasses a wide variety of households, it disproportionally affects those who are the most at risk when it comes to their health: the elderly and those with lower levels of income, education and/or English proficiency.
As a care coordinator for VNSNY CHOICE Health Plans, Alicia Schwartz, RN, works with older New Yorkers, many of whom have one or more chronic conditions, to keep them as healthy and safe as possible as they age in their homes. She and her VNSNY CHOICE colleagues work every day to educate plan members so they can better understand their diagnosis and plan of care, being ever mindful of risks, red flags, and next steps they can take if their condition changes. She’ll also teach them how to proactively communicate with their health care practitioners in the home, doctor’s office and clinic.
“It’s often hard and stressful for individuals to navigate their way through the healthcare system on their own,” says Alicia. “That’s where we come in.” For the elderly Bronx man who needed blood tests, for instance, she not only walked him through the goals of the tests his doctor had ordered, but also counseled him on ways he could improve his communication with his doctor so he’d be able to understand the plans and procedures he was facing ahead of time.
Here, based on her years of experience educating at-risk patients, are some valuable tips from Alicia on how to help raise America’s level of health literacy, one person at a time.
Meet People Where They Are
Whenever there is a new diagnosis, new medication or change in condition, Alicia begins the conversation by asking the health plan member to tell her what he or she knows: What did the doctor say about the member’s condition and about the plan of care? By hearing how the member understands his or her situation, Alicia knows where to begin the education.
“A member will tell me, ‘I’m on a low-sodium diet,’” she says. “But when I ask them what that involves and what foods it covers, they’re less sure.” Many people know that the restriction applies to canned and processed foods, she adds, but will still sprinkle salt on a homemade dish. In explaining what the member should and shouldn’t do, Alicia is also careful to keep the conversation specific and lay out clear steps to take.
Speak their Language
No matter how complex the member’s condition might be, Alicia makes sure to use easy-to-understand language. (The CHCS, in a series of fact sheets designed to boost health literacy, suggests making print, oral and electronic health information available at a fifth-grade reading level.) She’s also careful to give out manageable amounts of information in each conversation, addressing the most pressing needs at hand. If someone is dealing with diabetes and hypertension and has just developed pneumonia, Alicia focuses on the dangerous new condition — pneumonia — and leaves the details of less urgent conditions for another time.
How does she know if she is overloading someone with information? “When there’s a long silence on the line,” she says. To make sure people understand what she is telling them, Alicia often asks them to repeat back what they’ve heard. She can hear — and address — any gaps in communication this way.
Alicia emphasizes that health plan members who are more comfortable using a language other than English should always ask for a medical interpreter at a doctor’s office, even if they do speak some English. “Often the doctor will say, ‘English?’ and they say, ‘Yes,’ even though they are far more comfortable in their native language,” Alicia notes.
Encourage People to Ask Questions
“Always, always ask when you don’t understand something,” Alicia says, in what has become something of a motto for her. Still, she knows that many patients — particularly the elderly, not to mention those who speak little English — hold doctors in a position of authority and believe that the conversation should go only in one direction.
“When someone didn’t go to school or comes from another country, they tend not to ask questions of a doctor because they don’t want to appear dumb,” says Alicia. “That’s compounded by the stress that everyone feels in a doctor’s office. I emphasize to them that even I feel this in a doctor’s office when I’m dealing with my own health. But then I encourage them not worry about what anyone else thinks: this is their body and their health. They need to know.”
To help bridge the gap, she encourages health plan members to keep a notebook with their questions and bring the notebook to the doctor’s appointment. “That’s their homework — to have their questions right there in front of them in the doctor’s office,” she says.
Address Various Learning Styles
When one of Alicia’s patients with diabetes had trouble understanding how to find new sites for injecting insulin, Alicia left her with visuals that reinforced what the two of them had just discussed. Verbal information can be hard to hold onto amid the stress of managing one’s care, so having a picture goes a long way towards health literacy. It can also be helpful to have a family member present when the nurse or doctor demonstrates or discusses the plan of care, so the family member can provide learning reinforcement at a later time.
Medication Education 101
Medication management is a vital part of health literacy. Almost 40% of Americans age 65 and older regularly take five or more medications, and far too many Americans fail to take their medications properly. Alicia urges those in her care to bring a list of all their medications to all their doctors, and to ask for an updated list when they leave. And be attentive at the pharmacy when picking up medications, she urges; check that the prescription matches your doctor’s orders, and count the pills to be sure you have the right number.
Educating people about possible medication side effects is a balancing act, Alicia notes. She wants to make sure members know what to look for and take proper action when needed, but she doesn’t want to scare them away from taking their medications. If a medication causes nausea, take it with food, she advises; if the nausea continues, call the doctor and ask him or her to prescribe a different medication. But whatever you do, don’t stop taking the medication, she emphasizes; medications only work when you take them.
When it comes to health care, knowledge truly is power. The best way to stay on the path to good health is to know what to look for along the way. “Patient education is one of the most important and rewarding areas of health care,” says Alicia. “It’s gratifying when you’ve been working with someone on their diet and you see their blood sugar in the normal range and their blood pressure where it’s supposed to be. You know that they’re doing a good job and, even more important, they have the skills to keep doing well going forward.”