October is National Health Literacy Month, which encourages health care professionals to build bridges between organizations and individuals who need health care or services to create a more equitable world where everyone can access high-quality care and achieve positive health outcomes.
According to the Centers for Disease Control and Prevention (CDC), health literacy is important for everyone because, at some point in our lives, we will all need to find, understand, and use health information and services. Health literacy can help us prevent health problems, protect our health, and better manage health problems when they arise.
The Institute for Healthcare Advancement defines health literacy in two ways:
- Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
- Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
- Why is improving our nation’s health literacy important?
According to the CDC, when organizations or individuals provide health information that is too difficult to understand, a health literacy problem is created. When patients are expected to figure out health services with unfamiliar or confusing instructions, the problem is compounded.
Health literacy in the field
As a practicing physician, I would routinely see patients who would easily confuse medications that are labeled or packaged similarly. Health care professionals often interchange generic and brand names, which can add to the confusion for patients who are neither trained in medical terminology nor familiar with the fact that many prescription medications have a generic version.
Close to home
Recently, I experienced first-hand the importance of health literacy at home. A close family member was diagnosed with a serious illness. I saw how every family member reacted to the initial diagnosis and prognosis differently based on their level of health literacy. After explaining the diagnosis and prognosis in ways that everyone understood, we were able to be on the same page with my family member’s provider and everyone understood that the coming months would be filled with visits to specialists, weeks or months of treatment, or life-altering interventions as unsettling as that the care plan was. When patients and caregivers, like my family members, are confused or overwhelmed, those feelings can inadvertently result in not following through with treatment recommendations or misinterpreting critical information.
Health information can often be too difficult for the average patient to understand. Adults can face low health literacy when:
- They aren’t familiar with medical terms.
- They don’t understand the nuances of how their bodies function.
- They have to interpret statistics and evaluate risks and benefits that affect their health and safety.
- They are diagnosed with a serious illness and feel scared or confused.
- They have health conditions that require complicated self-care.
How can we help improve health literacy?
At Signify Health, we partner with health plan organizations to provide a more intimate clinical visit – one that takes place in the comfort of the health plan member’s home. These visits are performed by licensed clinicians - physicians, nurse practitioners, and physician assistants. These In-Home Health Evaluations (IHEs) are typically performed in person and individuals can also choose to have the appointment virtually through a secured network.
At no additional cost to the health plan member, the Signify Health IHE provides an opportunity to talk with a clinician who can answer questions and address concerns. These visits also help the clinician identify any social determinants of health concerns, including health literacy barriers, that may not be as easy to recognize in an office setting. In this way, we are able to address both organizational and personal health literacy.
By focusing on conversations and language the individual is comfortable with, we have seen that some recipients of the IHE are more comfortable in their personal living environment leading to more productive conversations – and solutions. The IHE offers an option where clinicians and health plan members can ‘speak the same language’ in a setting that doesn’t feel intimidating or rushed. This can also help to encourage consistent appointments between the individual and their regular physician and specialists.
Improving organizational health literacy
Encouraging patients to ask questions helps to engage and empower them in their health care journey is a first step for every organization that wants to implement a health literacy improvement plan. For example, Ask Me 3® is an educational program that encourages patients and their families to ask three specific questions of their providers to help them better understand their health conditions and the steps they need to take to maintain their health. Designed by health literacy experts, Ask Me 3® is intended to help patients become more active members of their health care team, and provide a critical platform to improve communications between patients, families, and health care professionals.
Providing easy-to-understand information about Ask Me 3® is one way providers could help engage patients and lead to more productive conversations. Patients who are feeling overwhelmed or intimidated may appreciate examples of questions to ask, such as:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do this?
There are a range of solutions that health care professionals can implement to help identify low or concerning levels of health literacy. Improving provider awareness by employing teach-back methodologies can also be effective. When asking a patient to repeat instructions they’ve just received or explain their next steps, health care teams have a better understanding of their patient’s comprehension and can respond accordingly.
National Health Literacy Month
Throughout October, health care professionals are reminded that health literacy is important and implementing steps to improve organizational health literacy can lead to improving patient’s personal health literacy.
Below is a list of tips and resources provided by the CDC for every practice to implement improvements to organizational and personal health literacy.
- Create and provide information and services that can help improve understanding. See Develop and Test Materials.
- Work with educators and others to help patients become more familiar with health information and services and build their health literacy skills over time. See Collaborate.
- Build upon your skills as communicators of health information. See Find Training for free, online options.
- Work with trusted messengers to share your information.
O In many communities, faith leaders are trusted messengers. See the CDC-funded Georgia Nutrition and Activity Initiative’s Live Healthy in Faith [6.4 MB, 95 pages] guide for ways to engage members of faith communities in sharing your messages.
O See Bridging the Gap for ways in which community health workers serve as trusted messengers.
- Build health-literate organizations.
O Attributes of a Health Literate Organization
O Assess Health Literacy in Your Organization
O Organizational Health Literacy: Quality Improvement Measures with Expert Consensus
- Consider the cultural and linguistic norms, environment, and history of your patient demographic when developing your information and messages.
- Use certified translators and interpreters who can adapt to your patient’s language preferences, communication expectations, and health literacy skill levels.
Additionally, the Health Literacy Month website includes valuable information including a Toolkit that can be used to help take action and spread the word about this important topic. Together, health care professionals and organizations can lead the charge to improve health literacy for those we serve. For more information about Signify Health, visit our website.
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Heidi Schwarzwald, MD, MPH, is the Chief Medical Officer for Signify Health Home and Community Services.