Transforming Patient Education: Effectively Identifying and Eliminating Barriers Related to Culture, Literacy, and Learning Styles

January 2022 Vol 13, No 1
Nakada Gusman, MSN, RN
Sarah Cannon Cancer Institute at HCA Houston Healthcare

The necessity for effective patient education has been widely recognized. The aim of patient education includes providing adequate and relevant healthcare information to increase understanding of conditions or interventions. Executing effective patient education is imperative. Well-educated patients are better able to comprehend and manage their own health and medical care. The patient education process empowers patients and promotes compliance, patient care satisfaction, and self-care; therefore, effective patient education decreases the financial and economic burden on individuals and communities. “Every USD 1.00 spent on patient education is estimated to save as much as USD 3.00-4.00 in healthcare costs.”1 In the United States, $69 million to $100 million are spent on healthcare problems caused by the lack of or ineffective patient education.1 With an end goal of transforming the patient education paradigm, healthcare organizations have noticed that nurses play a vital role. In particular, the implementation of nurse navigators within inpatient and outpatient settings has increased, with a focus on meeting individualized patient needs and education and bridging the gaps of a segmented healthcare system.2 Additionally, healthcare organizations have made patient outcome improvements related to education by reviewing and cultivating the patient education process, assessment, health literacy, learning styles, and digital education.

Patient Education Process

Patient education has long been considered an integral part of healthcare. The patient education process has 4 components that mirror the nursing process: assessment, planning, implementation, and evaluation. The first component consists of the assessment, followed by planning, implementation, and evaluation. Each component should be equally incorporated into the patient education process. Correspondingly, patient education should be based on evidence-based strategies to provide effective education to the patient. It should also be noted that the 4 components of the patient education process provide the foundation for any style of education.3


A basic assessment should consist of acquiring knowledge of the patient’s desire to learn, religious/cultural beliefs, potential emotional barriers, cognitive/physical limitations, and possible communication barriers. However, the assessment should not be limited to these basic inquiries. One of the most important questions a healthcare provider should ask a patient is “What are you worried about?” The purpose of this question establishes you are focused on the patient’s perspective and listening.3

The population of the United States is very racially and ethnically diverse. As the cultural diversity in the United States continues to expand, racial/ethnic minority populations are more prevalent, and the need to implement culturally diverse patient education is essential. In consideration, healthcare providers and organizations are developing and executing cultural competency patient education and curricula.

To assess and better understand possible cultural disparities in healthcare, a needs assessment should be implemented. Nationally, the United States has standardized guidelines on policies and practices directed at developing culturally competent healthcare systems known as culturally and linguistically appropriate services (CLAS). In particular, the CLAS standards are monitored in hospital settings by the Cultural Competency Assessment Tool for Hospitals (CCATH). CCATH was established as an organizational tool to assess the adherence of hospitals to CLAS. Furthermore, needs assessments may consist of community-based surveys, qualitative interviews, and secondary data sources. After disparities have been identified, healthcare providers should be vested in interventions, such as cultural competency training (CCT) programs, awareness of implicit biases, and behavioral changes. Implicit biases often exist beyond conscious awareness, and healthcare providers find them difficult to acknowledge and remedy. The attitudes and behaviors of healthcare providers have been studied, and implicit biases were identified. Hall and colleagues found that the implicit bias scores are similar to those in the general population.4 In fact, “implicit bias was significantly related to the patient–provider interactions, treatment decisions, treatment adherence, and patient outcomes.”4 The CCT programs assist healthcare providers and organizations in better understanding the knowledge and skills needed to work with diverse patient populations. With the completion of CCT programs, behavioral changes in communications and patient education materials are required. One primary implementation is the inclusion of language interpreters and patient education materials translated into primary languages of non–English-speaking patients. Other suggestions for the inclusion of cultural competency includes increased follow-up and more specific questions.5

Health Literacy

Patient education must be effectively executed through evaluating and improving health literacy. When defining health literacy in the healthcare arena, it is related to the capacity of a patient to understand and act on the health information given. Patients with low health literacy tend to have limited understanding of health communication. Patients with lower education levels, minority groups, and the elderly tend to have reduced health literacy. Patients with low health literacy often lack knowledge related to their disease or treatment options.6 To decrease barriers related to insufficient health literacy and improve patient outcomes, healthcare providers must spend more time with patients to increase their understanding of the education being presented. When time and energy have been invested in educating the patient, behavioral changes and health outcomes tend to improve. In addition, morbidity and mortality rates decrease related to preventable diseases.7

Developing partnerships between patients and healthcare providers is another factor related to improving health literacy and decreasing barriers. Healthcare providers are obligated to inform patients how to achieve health and wellness; in turn, patients have a responsibility to act on the information given. This partnership will improve patients’ health literacy and outcomes. To assist with buy-in from the patient, healthcare providers can use plain language while communicating verbally and in writing, incorporate the use of visual aids, make use of available technologies, and utilize effective teaching methods.

Healthcare providers should be mindful of variations of patient health literacy levels. Additionally, healthcare professionals should use terms and language that are understandable or relatable to laypersons. If not, communication of patient education may be misunderstood or lost in translation. Plain language with short words and sentences tends to make a greater impact on retention of the information. Likewise, patient education is better absorbed by the patient if the healthcare providers are conscious of the patient’s level of health literacy, cognitive ability, and self-confidence.8 This will increase the effectiveness of patient education and decrease barriers. Furthermore, patient education is greatly improved by promoting health literacy, increasing time spent with patients, and engagement.

Learning Styles

Each individual or patient has a distinctive way or manner in which the person is inclined to approach a learning situation or opportunity. This is known as a patient’s learning style. There are several frameworks of learning styles identified (eg, Visual, Aural, Read/Write, Kinesthetic [VARK] model). There are also a variety of tools that help identify an individual’s favored learning style, such as the Gregorc Style Delineator and the Kolb Learning Style Inventory. Some learning style frameworks, such as VARK, focus on how the learner obtains information via senses. Over time, learners have been known to have multiple learning preferences. This is known as multimodal in the VARK framework.9

When patients are identified as visual learners, graphics, maps, diagrams, and charts are preferred by the learner, according to VARK. Aural learners best obtain information or education via lectures, group discussions, and conversation. Read/write learners retain information via manuals and reports. Multimodal learners obtain education via demonstration, simulations, and practical applications. Therefore, the earlier a patient’s learning style is identified, the sooner appropriate educational materials or modalities can be utilized to increase knowledge retention.

Digital Education

Digital education incorporates the use of computers, audio/visual players, or mobile devices to tackle patient educational needs. Digital technology has become a standard method of providing patient education. Digital education provides flexibility for providing patient education and learning. Digital technologies also include the use of social networking sites, animation, and interactive features to promote patient engagement. Although digital education brings new opportunities and advancements to promote patient education, healthcare providers should be mindful of the required degree of technical savviness and health literacy required on the part of the patient. Over time, patient educators have continued to utilize digital platforms and tools in the computer-based environment.6 While the use of digital technology has increased, patient privacy and security are key focuses. Healthcare providers should utilize the provided digital security tools and software when providing digital education.


In summary, patient education should be simple, patient-centered, and multimodal while meeting the cultural literacy level and learning style of each patient. To close or narrow the gap in providing effective and relevant patient education, healthcare providers need to utilize all components of the patient education process (assessment, planning, implementation, and evaluation) to support the knowledge and skill acquisition for patients to provide self-care.3 Providing patient education that meets patients’ cultural, literacy, and learning styles will increase patient self-care and satisfaction and improve health outcomes.


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  2. Doerfler-Evans RE. Shifting paradigms continued – the emergence and the role of nurse navigator. J Thorac Dis. 2016;8:S498-S500.
  3. Cutilli CC. Excellence in patient education: evidence-based education that “sticks” and improves patient outcomes. Nurs Clin North Am. 2020;55:267-282.
  4. Hall W, Chapman MV, Lee KM, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105:e60-e76.
  5. McElfish PA, Long CR, Rowland BB, et al. Improving culturally appropriate care using a community-based participatory research approach: evaluation of a multicomponent cultural competency training program, Arkansas 2015-2016. Preventing Chronic Disease. 2017;14(E62):1-11.
  6. Lopez-Olivo M, Suarez-Almazor ME. Digital patient education and decision aids. Rheum Dis Clin North Am. 2019;45:245-256.
  7. Paterick TE, Patel N, Tajik AJ, Chandrasekaran K. Improving health outcomes through patient education and partnerships with patients. Proc (Bayl Univ Med Cent). 2017;30:112-113.
  8. Grebner LA. Addressing learning style needs to improve effectiveness of adult health literacy education. International Journal of Health Science. 2015;3(1):93-106.
  9. Tutticci N, Coyer F, Lewis P, Ryan M. High-fidelity simulation: descriptive analysis of student learning styles. Clinical Simulation in Nursing. 2016;84(7):919-927.
Last modified: August 10, 2023

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