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By
Todd Stein When psychologist Terry Davis led a focus group on health literacy in Chicago recently, she expected to uncover some reading difficulties in the participants. One in every five Americans cannot read the front page of a newspaper, according to the U.S. Department of Education, so it is normal to find functionally illiterate people in any randomly selected group. What Davis was not prepared for was the group’s nearly universal ignorance of basic health concepts. "Most people didn’t understand why, if they felt fine, they should get screened for colon cancer," said Davis, professor of medicine and pediatrics at Louisiana State University Health Science Center in Shreveport. "They didn’t understand words that we thought were common lay terms, like ‘screening.’ That level of illiteracy means healthcare providers and patients are in for a big mismatch in communication." Davis’ study is not the only one to point out major gaps in Americans’ understanding of medical concepts, or in their reading abilities. A recent study of English-speaking patients at public hospitals found that 27 percent could not read their appointment slips and 42 percent did not understand all the details on their prescription bottles. The American Medical Association estimates that about 90 million Americans lack basic health literacy – the ability to read, understand and act correctly on health information. Their mistakes and miscues cost the healthcare system $73 billion annually, the AMA estimates. Alarmed by such statistics, the AMA Foundation is preparing to launch a nationwide campaign in June to combat health illiteracy. It will focus on training physicians to spot health-illiterate patients and help them understand complex medical information. The program is the first of its kind, and has the financial support of most of the nation’s leading pharmaceutical manufacturers. Yet even its proponents admit that doctors are less central to the battle against health illiteracy than nurses. Nursing’s major role "Most doctors don’t have the time to educate patients," said Davis, who as a member of the AMA’s Committee on Health Literacy helped formulate the new campaign. "The reality is that it’s nurses who are more interested in patient education and have more training than the doctor." Even so, many nurses may not know the extent of the problem, nor what to do about it. Studies show that literate people tend to take literacy for granted. Yet, today’s patient education brochures, discharge instructions, medication pamphlets and consent forms are written at a level that exceeds the reading ability of most patients, said Ruth Davidhizar, DNS, RN, professor of nursing at Bethel College in Mishawaka, Ind., and a leading health literacy researcher. It doesn’t help that most patients who canread try to hide it. "They tend to nod their head and smile, because that saves the embarrassment of admitting they can’t read," Davidhizar said. "And a good nurse thinks that patient education has just occurred." Spotting health illiteracy Other clues that might indicate a patient is health illiterate include making excuses when asked to read something – "I forgot my glasses at home," asking if they can return a filled-out form later, or making gestures of frustration. The clues will vary with the patient’s background. Latino patients, for example, may simply remain silent during a discussion, Davidhizar said. "They don’t like to disagree with doctors or nurses because that would be disrespectful," she said. "A nurse who’s not culturally sensitive will take their silence for approval." Researchers are just beginning to study which education methods work best with health illiterates. In the absence of hard data, nurse educators suggest a straightforward plan of action that cuts through a patient’s attempts to look good but which avoids insulting them. Cathy Meade, PhD, RN, director of education at the Moffitt Cancer Center in Tampa, Fla., and a member of the AMA health literacy committee, asks two questions of any patient she suspects might be health illiterate: "What types of material do you like to read at home?" and "How do you like to learn about your health?" (with text, pictures or verbal instructions). If she has them read anything, she then asks them to describe the main point of the material. "The idea is to build up a cluster of clues to get a picture of the patient, then adjust how you use your skills to best serve that patient," Meade said. "The best way is to integrate the questions into your everyday bedside practice, while changing an IV or giving a bed bath. You have to use those teachable moments if you’re going to find the time to help these people." |
