Welcome to the Patient Educators Update. This is Episode 5 and our topic is Health Literacy.
Our guest is Fran London MS, RN. Fran is the Health Education Specialist at Phoenix Children’s Hospital in Phoenix, AZ. She has published dozens of articles and two books on Patient Education including No Time to Teach: The Essence of Patient and Family Education for Health Care Providers which is available in both print and e-book form where ever books are sold. Hospitals can save 40% on quantity orders directly from her publisher Pritchett and Hull.
The Patient Educators Update is brought to you by the Medical Media Delivery System – MMDS, the Video on Demand Patient Education Solution for hospitals and clinics.
The topic today is all about health literacy. This is one of those things that I hear a lot of educators talk about, but often wonder,”What do they mean?” You use a term called, “functional health literacy”. What do you mean by that?
Fran: The functional part refers to functioning. Health literacy is understanding something you read. But functional health literacy refers to the ability to function, to take that information, understand it and apply it.
For example, medication labels, forms, directions for what to do before a diagnostic test. Those are all things you have to understand and apply, in order to make it work.
The key thing is “apply”. Patients say they understand, but when you ask them, “Did you take your medication?” The answer is “ahhh, no.”
Fran: The ability to apply the knowledge is a whole other level. The patient can understand it and then choose not to apply it. But in terms of functional health literacy, you have to understand what it is they want you to do, and then how to do it.
Once we understand what functional health literacy is, how do we figure out, or assess if the patient has that ability? What do we do?
Fran: It’s actually not as hard as some people make it out to be. I like to think about the problem of having no time to teach, and how to be most efficient in dealing with your patient education time. Basically,if you do your regular assessment, if you just talk to the patient and findout where they’re at, you can assess for health literacy. The key really is the teach-back. If you have them teach things back to you as you’re teaching them, you can understand very early on whether or they’re getting it.
Not everybody is on the same education level, and I would imagine there are different levels of functional health literacy. What do you do if you suspect that either the patient or perhaps their family caregiver has low functional health literacy?
Fran: It takes some practice, but really what’s involved is listening to them. Then if you figure out that they’re having trouble understanding, like some people can’t tell time. So if you tell them to take a pill at a certain time, they don’t know how to do that. So, you ask them how they normally cope with things like this. In most cases you’re teaching adults. They function through life. They’ve had to get to appointments, they’ve had to get to a job. How do they function? What helps them figure it out? So, if you can ask them, “the last time you had to do this at a certain time? Do you need photos? Do you need your phone to remind you? What works for you so that you can cope with this?”
So, if I can interpret that? If somebody tends to focus aroundtheir mealtimes or bedtime. Then you would relate the time to take it around with meals or with breakfast, dinner, or at bedtime.
Fran: Exactly. Something that they associate it with.
So, you are relating things in real world terms, that they understand and relate to.
Fran: Exactly. You’re adapting how you teach, to meet their needs. It’s individualizing teaching.
You must understand how to individualize teaching. You should have done an assessment initially, so you understand where they are. Then by using teach-back, you’re able to maintain a benchmark throughout their hospital stay and in your communication.
There is a lot of emphasis on documentation (i.e. Medicare and Value Based Purchasing). What should you document?
Fran: Well, that’s not as important as documenting your evaluation of understanding results. What you really need to do is focus on what it is you know that the family or the learner has learned and document that. So that you have evidence that you can say, if you had to go to court, “Well,they did this. They “demonstrated the injection” or whatever. You document what you saw.
The emphasis is on what the patient or family member learned and demonstrated, as opposed to what you told them?
How does the patient educator decide what the learner should teach back?
Fran: Obviously, not everything. There’s a lot that you’re going to be teaching them that they don’t have to teach back. The goal of patient education is “functioning“. Can they take care of themselves? Do they know how to recognize problems? Do they know how to respond, when they have a problem? Those are the things to teach back. What are the basic skills that you want to make sure they have so that they can carry though and do their self-care? What are the issues that they have to look for, and can they teach those back to you? Do they know how to respond? Those are the important things, because if they don’t do that, that’s when they’re going to get into trouble.
For information on How to Use Video in Patient Education please download our free epaper on this topic for tips and ideas.