January 2001 • Volume 7 Number 1
Don't assume health literacy
BY SHERI PORTER
Mary Avila portrays a distraught babysitter who can't read prescription instructions for a sick infant in a skit at the Conference on Patient Education. Avila and her two teammates from Voz Inc., a nonprofit communication training organization in Albuquerque, N.M., brought an air of realism to the health literacy workshop: All three women know the stigma associated with receiving welfare, and two, including Avila, are adult basic literacy students. "There's a heck of a lot of folks out there who can't read what we're giving them and can't understand what we're saying to them," said Audrey Riffenburgh, M.A., speaking to health care professionals about health literacy at the 22nd annual Conference on Patient Education Nov. 16-19 in Albuquerque, N.M.
Riffenburgh is a founding member of the Clear Language Group, a consortium of specialists in health literacy. She helps health care professionals create effective, reader-friendly materials.
Is health literacy important to FPs? You bet it is, said Riffenburgh. "The more we expect of patients in terms of taking responsibility for their health care, the more critical it becomes that they understand what we're telling them. The consequences of misunderstanding can easily be life-threatening."
Health literacy should not be confused with basic literacy skills, warned Riffenburgh. The two overlap, but health literacy goes further, requiring the ability to read and understand health-related information, she said. Health literacy includes an overall understanding of how to use the health care system.
We're all illiterate in some areas, Riffenburgh said. She asked the audience to name subjects in which they feel incompetent. "Finances," said one physician. "Technology," said another. "Auto mechanics," offered a third. Exactly Riffenburgh's point. Someone may be very literate reading Popular Mechanics and have low health literacy.
Riffenburgh divided workshop participants into small groups and gave them lists of common medical terms and concepts to simplify -- a key step in helping patients achieve health literacy. "Efficacy" became "how well it works." "Sublingual" was simplified to "under the tongue."
"You want to tell patients everything you would want to know," said Riffenburgh. "But the risk of overwhelming is much greater than the risk of not giving them what they need to know. Ask yourself, 'What do my patients need to know to do the action I need them to do?'"
And keep in mind this fact: The average adult American reads at an eighth grade level.
Frances Biagioli, M.D., assistant professor of family medicine at Oregon Health Sciences University, Portland, shows participants in a child seat seminar where to find the date of manufacture on an infant safety seat. The older the seat, the less likely it meets current standards. Helen Cooley of Las Cruces, N.M., takes part in a Conference on Patient Education seminar on the patient's perspective on arthritis. She follows instructions to wrap a rubber band tightly around her hand to simulate arthritis pain. Riffenburgh teaches office strategies to help physicians and patients communicate better. Some suggestions include:
- Use models patients can hold and touch.
- Draw pictures on the exam table paper.
- Use the teach-back technique by having the patient explain what you've said.
- Sit down, take extra time and actively listen.
- Ask "What questions do you have?" rather than "Do you have questions?"
- Help patients save face by taking responsibility for any misunderstandings.
- Star, circle and underline important sections of written forms so the patient can easily find those points later.
- Simplify office forms and assign a staff person to discreetly help patients who experience difficulty completing them.
Tempting as it might be, Riffenburgh strongly cautioned physicians against testing to assess patients' literacy levels. "Literacy testing in the physician's office can do irreparable damage to the trust between patient and physician -- and that's if the patient comes back at all," said Riffenburgh, who can be reached at plnenglish@aol.com. "We don't need to assess reading skills. We just need to learn how to communicate well with all patients."
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