Health Literacy - Clear Communication - National Institutes of Health (NIH)

Health Literacy - Clear Communication - National Institutes of Health (NIH)

MEDLINE/PubMed Health Literacy Search

The MEDLINE/PubMed health literacy search retrieves citations published in English language journal literature that are the result of research. It is automatically updated by the National Library of Medicine at the National Institutes of Health.

Other Resources

Health Literacy Online
Office of Disease Prevention & Health Promotion

Training from HRSA
for professionals in clinical settings

Training from the CDC
for public health professionals

More about NIH Research on health literacy

Health literacy is: “The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” — Source: Healthy People 2010

Health Literacy

Communication between and among human beings is complex. It occurs at many levels simultaneously. Doctors, allied health professionals, public health communications experts grapple with how best to reach their audiences most effectively. Another concern is the need to inform whole populations about health emergencies, both on an immediate basis and into the future. Much study has gone into the effort to make clear communication, plain language, and visual communication as effective as possible, and this research continues.

Among ideas that emerge from these studies are

• We must not blame the individual for not understanding information that has not been made clear to him or her.
• Everyone, no matter how educated, is at risk for misunderstanding health information if the issue is emotionally charged or complex.
• In almost all cases, physicians and other health professionals, try to and believe they are, communicating accurate information.
• In some cases, patients may believe they have understood directions, but may be embarrassed to ask questions to confirm their understanding.
• Health care organizations and their systems and procedures have a significant role to play in ensuring understanding in the health care setting.
• It is increasingly difficult for people to separate evidence based information, especially online, from misleading ads and gimmicks.
• The communication of “risk” in an effective and fair way continues to be a challenge for both the provider and the patient.
• There are additional challenges in understanding how to select insurance plans and benefits, especially for those who have not previously been insured.

Some goals of a successful health information encounter

• The provider offers a clear understanding of what to do to improve one’s health, why is it being done, and, precisely, how to do it.
  “This medicine will lower your blood pressure, which will help your heart. You need to take the green tablets, with food. That’s one green tablet every day when you wake up with your breakfast, and one green tablet after dinner and before you go to sleep.”
  The provider needs to confirm the individual has a fundamental understanding of the information exchange, i.e. more than a nod of the head or an uh huh.
  Remember in school the teachers who said, “Any questions?,” gave the class no time to think of a question to ask, and moved on?
  You will probably remember more warmly the teacher who took the time to probe the question, “What do you think your risk is of having the complications I mentioned? What are you going to do with that information?”
• Using the “teach back” method , having the patient repeat the information back to the provider, can help in ensuring there has been understanding. Full Text 
• Ideally, skills related to “teach to goal” help the patient improve his or her own self management. Full Text 
• Health care systems can also address limited literacy. Full Text 

For example, Christina, has had a sore throat for two weeks. Her throat is not getting better. She finally goes to her neighborhood urgent care center. The staff hands her their "new patient" forms. The forms are not the same as any others she has seen before.

Among the questions are,

• “Are you receiving any medical care? If so, elaborate”
• “Do you drink alcohol?”
• “List the medicines you are using”

• Christina is at the urgent care center to receive medical care. The question is completely indefinite in terms of both the kind of “care” at what time, for this issue? or an annual physical? All the medical care she has received as an adult?
“Elaborate” is not the best word for people with reading or language challenges.
• This approach provides no real information to the health care provider. And may be questioned by the patient as not related to a sore throat? A better time to ask this would be when writing the prescription. That would relate to any potential negative reactions or interactions.

After presenting her insurance card and paying her co-pay, Christina is taken back to a treatment area.

What are some of the problems here?

Once in the treatment area, a physician's assistant takes a throat culture to determine if Christina has a strep infection, but forgets to explain that it is only a short term test, and that a second culture will be done in a lab to confirm strep over the next day. The medical worker wants to be sure the patient is treated or “covered,” so Christina leaves the clinic with an antibiotic prescription, and she takes it to the drugstore and has it filled.

Christina has trouble understanding the instructions, but does take the medicine for a few days. Her throat starts to feels better, and then she stops taking the medicine. She is reasoning that she is "saving" it for another time. Christina decides the next time she had a sore throat, she'll take the remainder of the prescription medicine and skip the urgent care center. She feels she’s being smart and thrifty, but she is making a poor choice.

What are the dangers connected to her decision?

Antibiotic resistance.

There are two main kinds of germs, bacteria and viruses. They both cause illness. Antibiotics can only kill bacteria. Although antibiotics can save lives, some germs get so strong they can resist antibiotic drugs. This is called resistance. The drugs don’t work as well. Germs can even pass resistance to other germs. The more a person uses an antibiotic, the more likely germs will resist it. Because antibiotics are used in a variety of ways including in acne medication or with animals used for food, there are additional sources of antibiotics to the system beyond prescribed medicines.

Yes, antibiotics can kill bacteria like the bacteria that cause tuberculosis, but they do not work against viruses. Examples of things caused by viruses are: ear infections, sore throats, sinus problems, coughs, bronchitis, flu, and colds.

So, what can Christina do to protect herself?

• Ask the provider why he or she is prescribing an antibiotic?
• Ask what else she can do to feel better sooner.

If the healthcare worker feels that the sore throat is a symptom of a bacterial infection and does prescribe the antibiotic, what can Christina do to protect herself?

• Take the medicine EXACTLY as prescribed. If she doesn’t understand the directions, she needs to ask the pharmacist and write down what is said.
• Don’t skip doses.
• Don’t stop taking the medicine because she feels better. Take all the doses.
• Don’t take leftover medicine.
• Don’t take someone else’s medicine.

The FDA is requiring new labeling for doctors. One of the new labels will say that antibiotics should only be used for bacterial infections. Another label will remind doctors to explain the right way to take antibiotics to their patients.