Healthcare Literacy: ‘Ask, Tell, Ask’: Understanding Care, for Better Care
It’s not uncommon for a patient to hear that he or she needs medication for hypertension but isn’t really sure why. Or gets nauseous taking a certain medicine and stops taking it. Or only remembers a fragment of the information received from a medical specialist.
According to the Center for Health Care Strategies, as many as 9 in 10 American adults struggle with what is known as health literacy. That means the degree to which a person can obtain, process, understand and apply the basic health information and services they need to make well-informed health decisions.
At Burke Rehabilitation, we use a number of strategies to help improve each patient’s health literacy as well as drive a culture of health literacy across our care teams and the organization as a whole. We listen actively, encourage questions and ask the patient to restate the information to make sure they understand and are comfortable with what they are learning. We use language that takes into account the patient’s culture, including preferred language, national and religious beliefs, and sexual orientation and gender identity.
“We are instituting the teach-back methodology—ask, tell, ask,” says Pauline Jones, M.Ed, FNP-BC, CRRN, Assistant Vice President of Nursing at Burke Rehabilitation. “We’re giving the patient spoken, written and visual information, and asking questions to ensure he or she understands,” says Pauline.
Pauline works with Juliette Kleinman, LCSW, ACSW, Director of Social Work Care, to educate the Burke healthcare team on health literacy. The social work team assess the patient’s health literacy using a validated health literacy screening tool.
‘The aha moment’
Years ago, Pauline had a healthcare episode that highlights just what we’re talking about when we discuss health literacy. She had tonsilitis—swollen tonsils, pain, difficulty swallowing—and she was prescribed medication in the form of a pill. It wasn’t until she got home that she realized: how could she possibly swallow a pill?
“I’m in healthcare, and I didn’t even think to ask a follow-up question—because I was in excruciating pain,” she relates. The provider never took the time to engage her in a conversation that surely would have revealed the fallacy of that care plan.
It’s hard to stick to a plan if you don’t understand it. It’s even harder if you are ill, uncomfortable or in pain. Unless patients have a fundamental understanding of the what, how and why of their care, they may miss appointments and fail to follow through with tests or specialist referrals. They may not to take their medications properly—or at all—which can worsen their condition. They may ask the clinician few or no questions even if they don’t understand the diagnosis or plan of care.
Low health literacy might produce unwanted health outcomes, stresses the health care system, and carries additional costs. It can also exacerbate health care disparities, as lower health literacy is disproportionately common in marginalized communities, including racial minorities, non-English speakers, and those with lower education and income levels.
To truly do right by our patients during and beyond their physical rehabilitation journey, we must actively seek, listen for and address any gaps in understanding. Knowledge is power, and by improving health literacy—on both a personal and system-wide level—we can empower patients to use what they know to make well-informed decisions about their health.
We can empower the patient with hypertension to visualize how her daily medication acts on her body to help the heart pump under less pressure. And the patient understands the implications of adhering to a prescribed medication regimen. A patient recovering from a hip replacement now knows all about her new joint and how to maximize her recovery, in rehab and at home.
Says Pauline, “When you spend time to educate and see the patient look at you and say, ‘Okay, I see why it’s important now’—that's the aha moment.”
