Health literacy is an ongoing issue in healthcare today. Low health literacy can be detrimental to a patient’s care. There are many interventions we can implement to improve patient literacy and empower them in their care.

Language

Imagine being in a different country where English is not the primary language. Maybe you are backpacking Europe and find yourself in a foreign country feeling pretty crummy. You head to the ER with a sore throat. You point at your throat, so they tenderly examine it. A nurse gestures to open your mouth and you do, expecting to have your throat inspected. You startle as they shove swabs in the back of your throat, checking for various illnesses.

Imagine being diagnosed with mononucleosis and being handed an “After Visit Summary” in a language you can’t speak or read. You can’t read that you should abstain from heavy lifting to your enlarged spleen and increased risk for splenic rupture. You don’t know how contagious it is, so you throw your heavy backpack onto your shoulders and hit the road with your friends. See the problem?

Columbus has the privilege of being home to countless diverse populations all over the world. Because many of our patients may have learned English as a second language, it is imperative to provide education in the patient’s primary language. Hospitals have many options in providing translations: in-person translators, phone translators, video robot translators, and more. I always make a point to introduce myself to my patient in their primary language with a translator so that I can explain their plan of care, provide education, and guide them through a physical exam. This allows them to be involved in their care. It is also an ideal time to perform an education assessment – what was their highest grade in education? How do they learn best – demonstrations or pamphlets?

Jargon

            Now that you are speaking the same language, you need to make sure you do not use lofty medical terms when speaking to a patient. First, most patients are not healthcare professionals and will not understand you. Second, patients tend to be less attentive and invested in conversations with healthcare professionals who use lofty, hard-to-follow terms. Figure out how to explain things in ways that make sense to the average, non-medical person. Instead of saying, “With your recent history of generalized malaise and weakness, the doctors’ differential diagnosis includes: Borreliosis, a demyelinating condition like RRMS, and hypovitaminosis D, so we will be performing phlebotomy tests and a magnetic resonance imaging study”, say something that sounds less scary. You could say “since you’ve been feeling tired and sick lately, we’re going to draw some blood to check for Lyme Disease and make sure you’re getting enough Vitamin D and get a scan of your brain to make sure there aren’t any changes that would make you feel this way.”

Education

            Now that your patient has a diagnosis, you have to explain this to them. This is crucial! You have a role in educating them about their illness and the interventions needed to get better. My grandfather returned from WWII and began working for the US Postal Service. As he aged, he developed many chronic illnesses, including atrial fibrillation. His doctor prescribed coumadin, but did not explain the rationale or importance to him. My grandpa did not understand the importance of having his INR checked frequently while on the medication and suffered an embolic stroke. I had been frustrated with him in his recovery period. I told him he needed to keep up with his appointments. After talking to him, I realized he had no idea why his INR needed to be checked or why he was on coumadin in the first place- “why would something for my heart affect my brain?” he asked. This conversation was the start of a long review of all of his medical conditions and treatments, in which I broke down each condition and told him why his medications and treatments were important.

Rapport

            Perhaps the most important factor in improving health literacy is the ability to build rapport with your patients. I try to build it with my patients as soon as I knock on their door in the morning. If you build a relationship, patients are more likely to express concerns or uncertainties with you.  I cannot count the number of times during bedside rounds the team asks a patient if they have any questions, to which they reply “no”, but quickly turn to me with questions as soon as the team walks away. Patients frequently express, “they were using words I’ve never heard before,” “I have no idea what they were talking about,” or “I was afraid to ask questions because I thought I’d look stupid.” I regularly make a point to check with my patients and their family members to ensure they understand their plan of care. Not only does it help them understand their disease, but it provides them with autonomy.

Kate Best is a 2015 graduate of The Ohio State University College of Nursing.