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Chapter 5
Health Literacy and

Clear Health Communication:

Keys to Engaging Older Adults and Their Families

Objectives (1 of 3)

Define the term health literacy.

Describe the health literacy skills of older adults according to their performance on the 2003 National Assessment of Adult Literacy, as well as according to other research studies.

Describe the impact of older adults’ limited health literacy skills on their health.

Describe the role of health system communication, processes, and demands.

Objectives (2 of 3)

List six plain language standards for verbal patient teaching.

Compare the reading level of health materials with the reading abilities of the majority of older adults, and discuss the mismatch or gap between them.

List 5 to 10 plain language standards for written information.

Objectives (3 of 3)

List three health professional organizations and three federal agencies that publish standards or policies related to health literacy.

Discuss how you can address health literacy in your health career.

Understanding and Using Health Care: Why Older Adults Often Struggle (1 of 4)

  • Health literacy challenges
  • Individual health literacy
  • “Degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions”
  • Also includes complexities and challenges presented by healthcare organizations

Understanding and Using Health Care: Why Older Adults Often Struggle (2 of 4)

  • Organizational barriers
  • Organizational systems and processes can be challenging for patients and providers
  • Providers and staff usually have little or no training in verbal communication skills
  • Patients and their families may struggle to understand print and web-based information

Understanding and Using Health Care: Why Older Adults Often Struggle (3 of 4)

  • Individual factors
  • Individuals may feel rushed, afraid, and too intimidated to ask questions
  • Other challenges patients may face:
  • Mastering arcane health insurance systems
  • Having specialized vocabulary, knowledge and skills to manage their own health
  • Using multiple information format in multiple locations to accomplish multiple tasks

Understanding and Using Health Care: Why Older Adults Often Struggle (4 of 4)

  • Additional barriers to adequate health literacy may include:
  • Diminished cognitive skills
  • Language and cultural differences
  • Lack of experience using technology and/or navigating the internet

Literacy, Numeracy, and Health Literacy Challenges (1 of 2)

  • Literacy
  • Includes:
  • Reading and writing
  • Speaking and listening
  • Thinking analytically and making decisions

Literacy, Numeracy, and Health Literacy Challenges (2 of 2)

  • Numeracy
  • Refers to a variety of skills, including:
  • Basic computing
  • Measuring and timing medicines
  • Assessing risk
  • Calculating percentages and statistics
  • Interpreting food labels
  • Reading medical devices

Impacts of Literacy and Health Literacy Skills: Two Major Keys to Good Health

  • Inadequate health literacy is associated with:
  • Greater risk of hospital admission
  • Higher likelihood of using emergency departments
  • Lower use of preventive health services
  • Poorer physical and mental health
  • Higher all-cause mortality

The Impact of National Policies on Health Literacy Practice (1 of 2)

  • From an organizational perspective, health literacy means:
  • Attending to communication demands placed on patients
  • How well or poorly an organization accommodates their communications needs

The Impact of National Policies on Health Literacy Practice (2 of 2)

  • Most organizations place health literacy demands on most adults significantly beyond their literacy skills
  • Situational stress further compromises their ability to absorb and process information
  • Communication disconnect results in serious consequences for care systems and patients

Accrediting, Standard Setting, and Policy Organizations (1 of 6)

  • Joint Commission
  • Accredits hospitals around the country
  • Identifies communication failures as the underlying root cause of 65% of sentinel events
  • 2010 Roadmap for Hospitals
  • Encourages use of plain language
  • Integrates health literacy with cultural competence
  • Reflects new accreditation requirements

Accrediting, Standard Setting, and Policy Organizations (2 of 6)

  • National Committee for Quality Assurance (NCQA)
  • 2017 Recognition Standards for a Patient Centered Medical Home calls for establishing processes that address health literacy

Accrediting, Standard Setting, and Policy Organizations (3 of 6)

  • National Board of Medical Examiners
  • Requires medical students to demonstrate communication competence on the United States Medical Licensing Examination

Accrediting, Standard Setting, and Policy Organizations (4 of 6)

  • American Medical Association (AMA)
  • Publishes policy statements and white papers alerting physicians about the dangers of “medspeak” and how to improve communications

Accrediting, Standard Setting, and Policy Organizations (5 of 6)

  • Allied health professions organizations
  • Have urged consideration of health literacy in policy statements and by promoting resources for student and practitioner learning

Accrediting, Standard Setting, and Policy Organizations (6 of 6)

  • National Academy of Medicine
  • Health Literacy Roundtable has resulted in numerous publications linking health literacy and key healthcare issues
  • Vital Direction for Health and Health Care
  • 2017 report links attention to health literacy with the changing expectations of health care to improve quality, achieve better outcomes, and reduce costs

Federal Government
Agencies (1 of 3)

  • Plain Writing Act
  • Requires all government information created for the public be written in plain language
  • Centers for Disease Control and Prevention
  • Offers the Clear Communication Index, an assessment tool for written materials

Federal Government Agencies
(2 of 3)

  • National Institutes of Health
  • States that health literacy “Saves Lives. Saves Time. Saves Money.”
  • Agency for Healthcare Research and Quality offers:
  • Health Literacy Universal Precautions Toolkit
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys for patients to assess quality of care

Federal Government
Agencies (3 of 3)

  • Department of Health and Human Services
  • Updated Cultural and Linguistic Access Standards (CLAS) requires “easy-to-understand print and multimedia materials and signage”
  • Office of Disease Prevention and Health Promotion
  • Promotes the National Action Plan to Improve Health Literacy

The Business and Legal Case for Health Literacy (1 of 2)

  • Centers for Medicare and Medicaid Services
  • Use standardized patient satisfaction data captures in CAHPS surveys to help determine merit-based incentive payments
  • Medicare hospital reimbursements for patients with traditional Medicare are based partly on “Value-Based Purchasing”
  • Hospitals with superior patient experiences generate higher financial return

The Business and Legal Case for Health Literacy (2 of 2)

  • Risk avoidance
  • Assuring informed consent helps healthcare providers and systems avoid needless risk
  • Means that written and verbal information is understandable to the patient or patient’s agent
  • Poor communication is a major cause of malpractice claims

Clear Health Communication: An Often Overlooked Necessity
(1 of 2)

  • Communication is often treated as an afterthought
  • Questions:
  • How best to communicate?
  • What will motivate leaders of healthcare systems to systematically address communication challenges?
  • What are the best solutions?

Clear Health Communication: An Often Overlooked Necessity
(2 of 2)

  • Certain techniques increase the likelihood that adults will be able to understand and use health information
  • Teaching techniques such as “teach back”
  • Plain writing techniques such as avoiding jargon
  • Joint Commission report
  • Contains 35 specific recommendations for improving communication

What Is Plain Language? How Will I Know It If I Hear It? (1 of 2)

  • AMA verbal communication tips:
  • Slow down
  • Use plain, nonmedical language
  • Show or draw pictures
  • Limit the amount of information and repeat it
  • Use the teach back technique
  • Create a shame-free environment

What Is Plain Language? How Will I Know It If I Hear It? (2 of 2)

  • Additional tips to help older adults learn more effectively from healthcare visits:
  • Frame the conversation first
  • Encourage older adults to bring a friend or family member to the visit
  • Give plain language–written information that reminds the patient of what to do, how to do it, and why

What Is Plain Language? How Will I Know It If I See It? (1 of 3)

  • Plain language guidelines
  • Content
  • Information is accurate, up-to-date, and limited
  • Focus on behavior
  • Break up complex information
  • Structure/organization
  • Structure from the user’s perspective
  • Convey key points in headings
  • Begin with clear action messages

What Is Plain Language? How Will I Know It If I See It? (2 of 3)

  • Plain language guidelines (continued)
  • Writing style
  • Talk directly to the reader in a positive, friendly tone
  • Use everyday language
  • Explain the meaning and pronunciation of any medical terms that are used
  • Keep sentences short
  • Use mostly active voice
  • Include testimonials or short example stories

What Is Plain Language? How Will I Know It If I See It? (3 of 3)

  • Plain language guidelines (continued)
  • Appearance and appeal
  • Make sure print materials and websites are attractive and inviting, and look easy to read
  • Include sufficient white space
  • Use large enough print for reading ease
  • Limit the use of fancy typefaces and underlining
  • Use appropriate images to humanize materials

A Call to Action (1 of 2)

  • There is no one solution to the complex problem of communicating effectively with diverse patients and audiences
  • Well-planned and simply written information and the use of teach back can improve understanding

A Call to Action (2 of 2)

  • Healthcare professionals
  • Must take the lead in learning effective verbal and written communication techniques
  • Healthcare organizations and systems
  • Must build health-literate organizations
  • Communication excellence
  • Essential to thrive in the era of “pay-for-performance” and “bundled care”