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What you can do to make your
patients understand you better
"Teach-back" method Ask
your patients to repeat your explanations and
instructions back to you to make sure they are
grasping them.
Communicate clearly Use
plain language, tailor the information according
to your patients' needs and explain instructions
more than once.
Be sensitive to clues
that patients might have literacy problems, like
reluctance to fill out forms or relying on others
to read information to them.
Helping hand Make your
practice supportive to people with low-literacy
by asking nurses or office staff to help patients
fill out forms or by making audio-visual material
available.
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One day, years ago, an elderly
patient arrived at Dr Paul Cappon's family practice
with what appeared to be some cardiac complications.
"I explained to her at great length what I considered
the issue to be," he says. "I thought I was being understood."
But when she came in for a follow-up a month later,
he realized she hadn't understood a thing he'd said
and hadn't taken any of the meds he'd prescribed. "This
is not an uncommon occurrence," he sighs.
Dr Cappon is now the president
and CEO of the Canadian Council on Learning (CCL), and
devotes much of his time to improving Canadians' —
and especially elderly Canadians' — health literacy.
Roughly defined as how well a patient
understands explanations and instructions about their
care, health literacy now registers on most physicians'
radars. But that doesn't mean patients understand any
better what's going on. According to a recent CCL report,
55% of Canadian adults came in below suggested health
literacy levels. Even more shocking, says Dr Cappon,
is the fact that that figure skyrockets to 88% for Canadian
seniors. (Fifteen percent of Canadians are classified
as functionally illiterate, and 42% are semi-illiterate
overall.)
CAUSE
FOR CONCERN
Below-average health literacy can hinder a patient's
ability to understand dosage directions ("Take two pills
twice a day" is a good example of an instruction that
confuses many patients) or comprehend written material
about nutrition or lifestyle changes. It can also discourage
them from asking questions because they may be ashamed
or worried they won't understand the answers. A number
of studies have drawn convincing links between health
literacy and health status, including one 2005 Archives
of Internal Medicine report that found poor health
literacy was independently associated with reduced measures
in physical function, mental health, the ability to
complete daily activities and a higher incidence of
pain that disrupts work. Though the measure used was
not the same as the one the CCL uses, the message is
clear: poor health literacy translates to poor health.
"The other thing that's striking
is that health literacy skills decline over people's
lifetimes," says Dr Cappon. "That decline occurs in
every population over time, as people get older. But
in Canada, we lose our skills faster than other Western
countries." He cites three reasons for Canadian seniors'
accelerated slide: one, early childhood learning is
not sufficiently prioritized, and health promotion programs
are largely absent from schools; two, workplace training
is almost nonexistent here compared to Europe; and three,
"a paucity of community resources for ongoing learning."
This decline means that as Canadians age, they lose
their general literacy skills — including health
literacy — just when they may need them most.
MISSING
IN ACTION
Irving Rootman, PhD, a health promotion researcher at
the University of Victoria and an advisor to the CCL's
Health and Learning committee, says the state of health
literacy in the elderly is one of the biggest challenges
in the field today.
What's needed, Dr Rootman argues,
is aggressive leadership from Canadian physicians. "In
the States, there have been a number of very active
physicians who have undertaken research in the field
of health literacy and helped to put it on the map,"
he explains. "Whereas in Canada, there are very few
physicians who have spoken up about issues around health
literacy and very little research out there."
Dr Rootman also bemoans the lack
of support for literacy issues provided by the federal
government. In September 2006, the government cut $17.7
million in funding to the Adult Learning, Literacy and
Essential Skills Program, a decision that Movement for
Canadian Literacy executive director Wendy DesBrisay
likens to "pulling the rug out from under" them.
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