Lessons and Tips from the Literature

LESSON: Most people with low literacy skills can reasonably compensate for their lack of reading skills and understand health information.(1,2,3)

TIP:  Create a respectful, shame-free environment. For example, "Lots of people have a hard time reading and remembering so much information. Do you have any problems with it?" Or, "Is there someone at home who helps you remember when to take your medications?" 

TIP:  Speak slowly, simply, and directly.

TIP:  Eliminate jargon and "medicalese". 

TIP:  Read written instructions aloud.

TIP:  Underline important words.

TIP:  Use the teach-back technique. For example, "How would you tell a friend to this?"

LESSON: Persons at all literacy levels prefer simple health education materials because they are unfamiliar with the health care environment and feel a lack of control within it.(1,4,5,6,7, 8) 
TIP:  Focus on patient behavior and not on medical facts. For example, "Here's what to do when you have an asthma attack."

TIP:  Introduce only 2 to 3 concepts or new words at one time.

TIP:  Supplement instructions with pictures, or even a video, when possible.

TIP:  Simplify dosage and scheduling of drugs by tying them to daily routine and events. 

LESSON: A patient-centered interview consumes only 1 to 2 1/2 minutes more than the traditional physician-centered model and transcends barriers to the 3 interview functions of information gathering, relationship building, and patient education.(9,10,11,12,13,14, 15,16,17,18,19, 20) 

TIP:  Begin the interview by allowing the patient to tell his story uninterrupted because the first complaint is not always the chief complaint.

TIP:  Guide the interview by using open-ended questions. For example, "What's been going on since I saw you last?" or "Tell me more about that." 

TIP:  Use linguistic devices called "continuers", such as "I see", "Uh huh", "Okay," "Anything else?," until the patient has finished.

TIP:  Negotiate an agenda. "Of all these problems, which one is most important to you?" 

TIP:  Repeat what the patient has said to confirm the facts and show empathy, as in "Let me see if I have this right."

TIP:  Express empathy when the patient is not doing well. For example, "I wish there were better treatments available." 

TIP:  Legitimize the patient's feelings. For example, "I'd be surprised if you weren't anxious about this." 

TIP:  Compliment the patient's effort, as in "You're doing very well managing this therapy at home."

TIP:  Conclude the interview by allowing the patient to participate in the decision to finish. For example, "Is there anything else you'd like to tell me?" 

LESSON: Increased awareness of health literacy among office staff fosters a team approach to its management.(21,22,23,24)
TIP:  Alert staff to clues of low literacy skills, such as patients' frequently missed appointments or excuses for not knowing names of their long-term medications.

TIP:  Encourage patients to bring the actual medication containers instead of a list of medications to each visit.

TIP:  Color code patients' medications.

TIP:  Involve nursing staff by follow-up phone calls.

TIP:  Provide a surrogate reader if the patient needs one.

TIP:  Use free, non-intimidating sources of information, such as hospital-sponsored "Ask-a-Nurse" programs or patient resource rooms.

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