Poor health literacy leads to poor health outcomes, according to Carla Schaefer, BSN, RN, OCN, Associate Director of Nursing Infusion Services at Rutgers Cancer Institute of New Jersey. But helping patients to comprehend complex health information decreases their risk of negative outcomes while providing an optimal approach to patient-centered care.
As the medical field grows increasingly complex and services continue to move to the outpatient setting, a focus on health literacy becomes more and more important. “As nurses, we are jacks of all trades—we’re plumbers, electricians, counselors, and teachers—and every minute of every shift we’re teaching our patients, their families, and each other,” she said at the Academy of Oncology Nurse & Patient Navigators (AONN+) 8th Annual Navigation & Survivorship Conference.
Nurses are essential to the effective delivery of patient education, but when a patient’s health literacy is not assessed before the delivery of crucial information related to their cancer, effective communication goes out the window.
The World Health Organization defines literacy as an individual’s ability to read, write, listen, comprehend, and speak a language, whereas health literacy requires those basic skills in addition to the ability to obtain, process, and understand health information. “We have to know where to get the information, and once we have it, we need to know how to process it and use it to make informed decisions,” Ms Schaefer said. Importantly, excellent literacy skills in a nonhealthcare environment do not always translate to good health literacy.
The Impact of Health Literacy
Poor health literacy has a cascade effect. It leads to suboptimal decision-making, poorly managed chronic conditions, increased use of emergency services, higher incidences of preventable hospital admissions, and in turn, the increased cost of healthcare. And what is often mistaken for noncompliance could be as simple as a patient being unable to read the instructions on a pill bottle.
Many barriers contribute to a patient’s ability to comprehend health information, including emotional distress, patient expectations, fear of dying, and being overwhelmed with information. These barriers are not always limited to a patient’s ability to read and write, and the risk of negative outcomes increases as these contributing barriers come into play.
How Do We Improve?
Small interventions can have a big impact in terms of health literacy. Staff should be uniformly educated on the topic, and competency should be assessed regularly. “Follow that up with cultural humility,” Ms Schaefer advised, “This is defined as the sensitivity to the way in which community members’ values and perceptions about healthcare differ from our own; everybody’s culture is different, every patient is unique, and we need to take this into account.”
Proper assessment of patients includes determining existing barriers and preferred learning methods, keeping in mind that the “learner” is not always the patient; it could be a family member or caregiver. “One of the biggest barriers for us as nurses and navigators is that we don’t know what a patient’s barriers are,” she noted. “But you have to be prepared for all of them when you encounter a patient for the first time.”
Barriers that could affect learning outcomes include lack of emotional readiness, poor vision/hearing, cultural/religious practices, low literacy/education level, financial concerns, and language. Useful tools for quick assessment of health literacy include Rapid Estimate of Adult Literacy in Medicine, Short Assessment of Health Literacy – Spanish and English, Test of Functional Health Literacy in Adults, and Newest Vital Sign.
But according to Ms Schaefer, communication is the most vital element. “We can assess health literacy, learning preferences, and barriers, but if we’re not communicating effectively, none of those other things make a difference,” she said.
Prioritize teaching order, ask open-ended questions, and encourage patients to use their own words when answering. When teaching something non-verbal (ie, infusion, self-care), employ the teach-back method to ensure understanding and always use universal precautions, teaching everyone in the same fashion, in plain language and assuming low literacy, she advised. Ensure an environment of safe and efficient care by documenting communication and reassessing it frequently, because patient needs and barriers change throughout the course of treatment.
“There’s no sense in reinventing the wheel, going over things that the patient already understands,” Ms Schaefer added. “Document not only what they’ve been taught, but also the evaluation of what they’ve learned.”