Stericycle Communication Solutions

Does oversimplifying patient instructions boost health literacy?

Health Literacy continues to be a major issue in health policy and reform in the United States and across North America. According to The Health Literacy of America’s Adults, more than one-third of U.S. adults have limited health literacy, making it difficult for them to read, understand, and apply health information including wording on medication bottles, instructions, and health education materials.* Just recently, an article was published by the American Academy of Family Physicians (AAFP) that suggested healthcare professionals should simplify their instructions to patients and provide understandable and accessible information to all patients regardless of their literacy or education levels. This includes avoiding tough medical terms and limiting information or instructions into fewer concrete steps.

In the past, healthcare providers just assumed that patients understood what they were being told to do, which is a bold assumption considering the stats we know about health literacy in North America.  There are many different views on how exactly to combat and increase health literacy.

Some believe strongly in promoting health literacy in healthcare organizations using “universal precautions,” a set of guidelines that help physicians make simple changes in their offices to better communicate with their patients about health information and enhance support for patients of all health literacy levels*. They aim to simplify communication and confirm comprehension for all patients, in order to minimize miscommunication, make the office environment and healthcare system easier to navigate, and support patients’ efforts to improve their health*.

Lead author of the recent AAFP article, Lauren Hersh, M.D., from the Thomas Jefferson University in Philadelphia, recommends the following suggestions:

  • Use universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels, such as avoiding complex medical terms and breaking down information into small concrete steps.
  • Prioritize and limit information to three key points or tasks for each patient visit.
  • Use the teach-back method where the patient explains the information back in their own words to gauge comprehension.
  • Simplify forms and offer assistance for completing them.

Dr. Brian Goldman, ER physician from Mount Sinai Hospital in Toronto, Ontario has a slightly different opinion on things.  He believes that oversimplifying the information only perpetuates poor health literacy and does not encourage the patient to take part in their own health.  He suggests that there are other things that both patients and healthcare professionals can do to boost health literacy and increase the line of communication and comprehension.*  

  • Patients can ask more questions to better understand.
  • Have a family member or friend present to assist in asking questions.
  • Don’t be shy, if you do not understand something, make sure to communicate this to your doctor.

Goldman suggests it’s not just the patients who have to do the work.  There are plenty of things that health professionals can do to promote increased health literacy.

  • Speak to your patients in a way that they understand – it goes a long way. Patients may find it difficult to understand complex words,  numbers or percentages. Rather than saying that there is a five percent risk of getting colorectal cancer in your lifetime, health professionals can rephrase it by saying that 1 out of 20 people will get colorectal cancer during their lifetime.  
  • Rather than asking “Do you have any questions,” ask “What are your questions?” This lets the patient feel comfortable and  know that it is normal to have questions.
  • Some patients find it hard to remember doctor’s instructions or suggestions after their appointment is over.  Sending automated follow-up reminders to patients regarding their health instructions is a simple way to jog a patient’s memory and keep them healthy at the same time.

No matter which way you slice it, the theme for health literacy is clear to me.  Communication is key.  Open and clear communication between healthcare providers and patients is the first step to better understanding and health outcomes.  Whether you are communicating using simple straight forward instructions that everyone can understand, operating in an environment where patients feel comfortable asking more questions or adopting tools and services like automated communication solutions to assist patients with ongoing health; the first step to communication is to have it and to continually improve on it.