HJAR Jul/Aug 2021

HEALTH LITERACY Q&A in an effort to reduce the demands placed on learners. Instead of sharing everything the patient might ever need to know, all in one sitting, explore some options to break this information up into more manageable chunks. Consider whether you might have an opportunity to split the learning objec- tives over multiple visits or to share the most important points verbally and send home additional reference information (assuming that the patient can learn using written materials). The last major concern I will share is the illusion that learning took place. Even when you pare down the information to what a patient or caregiver needs in that moment, and although you may do a wonderful job using “living room language” rather than jargon, the fact that you delivered a mes- sage does not guarantee that the patient or caregiver learned anything. Similarly, your supplementation of verbal instructions with written instructions does not ensure that the intended learning objectives were met. The only way to know for sure is to ask. And it’s not enough to ask, “Do you have any ques- tions?” Remember, they are tired and not feeling well, so saying, “I’m fine,”is just eas- ier. Some patients even tell us they feel badly for the people still waiting to be seen, so they simply say they understand and leave your office with unanswered questions. To assess whether your intended messages landed successfully, I encourage you to use the teach-back method. Here are the steps: 1. Teach small chunks of information (up to three key messages), then pause. 2. Explicitly invite the patient to teach those key messages back to you. To avoid the patient feeling as though you are testing them, be clear that you are testing yourself. You could say “I want to be sure I did a good job explaining how you will take this new medicine. Can you tell me in your own words how you will take it?” 3. Correct any inaccurate or missing information. Reteach, remembering to use plain language. What segments of Arkansans have lower levels of health literacy; what best practices have you found to better communicate with these groups? There are some populations with known risk for health literacy challenges. Those include older adults, people with chronic diseases, those from racial and ethnic minority groups, and people with limited education or income. But, given the many barriers to learning in a healthcare environ- ment, anyone can struggle with health infor- mation. A “universal precautions”approach suggests we treat everyone as though they may have difficulty with the health infor- mation we share. That means we follow the practices described above (limit the amount of information we share in one sitting, use plain language and confirm understanding with teach-back). For those who think perhaps their patients have higher health literacy skills, consider this: everyone benefits from clear communication. I challenge anyone to find another person who hasn’t experienced the desire for more clarity in communica- tion. My husband is well-educated, but we don’t share a profession, and he is quick to point out my use of jargon. In fact, he once accused me of making up words when he heard me use “comorbidities” in a sen- tence. When we receive a health services billing statement that is confusing or need to complete paperwork for our daughter’s care, he defers to me, because the language is often not as clear as it could be. Most of us have seen written materials that left us uninformed or frustrated, so making things clear for all can only help. All of this said, some patients need more than clearly articulated instructions. If you have an opportunity to use validated patient health literacy screening, it can certainly serve as a reminder that the person in front of you needs extra support. In addition, health literacy screening could contribute to population health efforts by identifying the patients whose health literacy status increases the likelihood that they will miss valuable information. Studies have shown that 40-80% of the medical information patients are told during office visits is forgotten immediately, and nearly half of the information retained is incorrect. “Instead of sharing everything the patient might ever need to know, all in one sitting, explore some options to break this information up into more manageable chunks.” 18 JUL / AUG 2021 I  HEALTHCARE JOURNAL OF ARKANSAS