How Providers Can Meet Varying Levels of Patient Health Literacy

To say patient health literacy is important to patient engagement, activation, and experience is not a particularly blistering-hot take.

Patient health literacy, or more specifically, personal health literacy, refers to an individual’s ability to understand and use health information. To that end, high personal health literacy is essential to ensuring patients can understand a diagnosis or a treatment plan and then have the self-efficacy and management skills to follow through on that treatment plan.

But the challenge to providers is that high personal health literacy isn’t exactly common, and it’s hard to know exactly where patients need their clinicians to meet them.

According to the Department of Health and Human Services, as few as 12 percent of people in the US have proficient health literacy levels. Meanwhile, a whopping 36 percent of people have low health literacy, a problem some economists estimate costs the US $236 billion annually in medical errors, increased illness or disability, lost wages, and compromised public health.

Those hurdles, plus the finite amount of time allotted for every clinical encounter, can make it so providers can’t actually meet patients where they are in terms of health literacy, despite best intentions. After all, even though low health literacy is common, providers don’t always know which patients have low health literacy. While there are some screeners for health literacy, not every provider has them available, and not every provider has the time to conduct them.

Greg O’Neill, MSN, APRN, AGCNS-BC, director of Patient & Family Health Education at ChristianaCare in Delaware, is trying to change that. Through the Health Literacy Council of Delaware, of which O’Neill is chair, he and colleagues are working to create a unified plan across the state for how to improve personal health literacy.

“We are really excited about the Health Literacy Council of Delaware,” O’Neill said in an interview with PatientEngagementHIT. “This is an opportunity to bring our entire state together under a unified plan. We started out with a statewide strategic plan. We brought about 100 different stakeholders together to really identify those initiatives that we thought everyone could get behind to improve the health literacy strategy in our state.”

The Health Literacy Council of Delaware has also created a set of subcommittees tasked with addressing policy and advocacy issues, provider education and training, and community engagement and outreach, O’Neill added.

Backed by ChristianaCare, the Delaware Division of Public Health, and the University of Delaware’s Partnership for Healthy Communities, the Council recently received $80,000 in funding from Highmark Blue Cross Blue Shield Delaware.

The funds come from Highmark’s BluePrints for the Community program and will particularly focus on provider awareness and education. The funding is intended to help healthcare organizations enable patient access to health information in a way that supports patient health literacy levels, according to a press announcement.

O’Neill said a good health literacy strategy begins with assuming most patients don’t have good health literacy. Citing the figures above, O’Neill pointed out that low health literacy is really widespread, so it’s best for healthcare providers to start at an accessible baseline when communicating with patients.

“Because it is such a widespread issue, the best approach is to assume that everyone has low health literacy,” O’Neill advised. “Start there, and then you can adapt your interventions; you can adjust what you're doing with the patients and families to meet their needs. We really need to meet people where they are.”

Healthcare providers should consider using plain language during patient-provider communication and steer away from using too much medical jargon, he added. Using strategies like patient teach-back, healthcare providers can then assess patient understanding and, by extension, health literacy in real time. That lets providers adapt their interventions or change tactics should a patient demonstrate particularly low or particularly high health literacy.

Conversely, it’s also important for healthcare providers to steer clear of language or communication traps that could let patients hide that they don’t understand.

“One of the big red flags in that situation is going to be yes and no responses,” O’Neill noted. “So that's why, in this area, we really need caregivers to be asking open-ended questions. If you're asking an open-ended question and you're not getting a lot of information back, that's a signal that that person may not really be understanding what information you need them to understand.”

O’Neill recommended providers also pay attention to non-verbal cues, like shifting in one’s seat or other signs of minor discomfort, during a conversation. This could also indicate that the patient does not understand something about the diagnosis or care plan.

But above all else, O’Neill urged providers to integrate teach-back—the process of asking patients to repeat back medical information in their own words—to check understanding.

Fundamentally, the onus of patient health literacy falls on the provider, O’Neill stressed. That’s a concept called organizational health literacy, or the ways in which an organization supports or facilitates information access for all patients.

The Health Literacy Council of Delaware emphasizes the role healthcare providers play in supporting patient health literacy, and that includes actions taken outside of the individual patient encounter.

“We do not want to be making it a heavy lift for the patients and families when they come in to see us,” O’Neill explained. “That said, there may be some things that we can do to help them feel empowered and build their confidence.”

At ChristianaCare, patients might see signs in clinical spaces that encourage them to ask questions. Some providers set expectations that they are going to use teach-back during the clinical encounter, which in itself might motivate some patients to ask questions throughout the care encounter.

At the end of the day, this kind of comprehensive health literacy strategy is essential to addressing patient care goals, promoting health equity, and promoting a good patient experience.

“At ChristianaCare we have a few core behaviors that we utilize, and those include anticipating the needs of others, listening actively, and seeking to understand,” O’Neill said. “And if we're going to live up to those behaviors, we are certainly going to need to address the health literacy needs of the folks that we're caring for.”

“It's really important to recognize that if someone feels heard and seen in their healthcare encounter, and if they leave that encounter with a better understanding of their health, it's going to improve their experience,” he concluded.