Health Literacy Issue of Patient and Nursing Education

Nursing Education and Patient Health Literacy

Why People  Should be Provided With Health Literacy,Goals of Health Literacy for Next Ten Years,Guideline and for Nurses and Healthcare Provider for Health Literacy Issue,Conclusion About Health Literacy Issue and Role of Nurses.

Areas Need Attentions to Overcome Health Literacy Issues

    In 1999, the Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs of the American Medical Association acknowledged that, although a great deal had been learned to date about the magnitude and consequences of the problem of illiteracy and low literacy, further research efforts had to focus on four areas:

1. Literacy screening

2. Methods of health education

3. Medical outcomes and economic costs

4. Understanding the causal pathway of how health literacy influences health status

Why People  Should be Provided With Health Literacy

The committee also called for healthcare policies to address the issue of health literacy for the following reasons:

1. Low literate patients cannot be empowered consumers in a market driven healthcare system.

2. Patients who cannot understand healthcare instructions will not receive high quality health care.

3. Healthcare professionals are subject to liability for adverse outcomes in patients who do not understand important health information.

4. Clinical management problems are likely to result in substantial but avoidable costs for the US health care system.

5. Health literacy problems are more prevalent in certain populations (e.g Medicare beneficiaries, Medicaid recipients, and uninsured individuals).

Goals of Health Literacy for Next Ten Years

    Indeed, based on the findings of the NALS and NAAL reports, a broad policy agenda on health literacy has been put forth in the 10 year goals and objectives of Healthy People 2020 (USDHHS, 2014). The topic area “Health Communication and Health Information Technology” includes an objective specific to health literacy improvements and addresses three major health literacy initiatives: prevention measures, interaction activities between healthcare providers and clients, and navigation of the healthcare system. 

    Although the literacy and verbal skills of individuals are concerns of critical importance , so also are the demands made by PEMS, the need to improve communication skills of health professionals, and the need to make the healthcare system less complex.

    Specific reports by the IOM, the AHRQ, and the AMA, all published in 2004, recognized that health literacy is a key priority in transforming the US healthcare system (Aldridge, 2004; Weiss et al., 2005). Specifically, AHRQ examined the relationship between literacy and adverse outcomes as well as interventions to improve outcomes for people who are low literate (Pignone et al., 2005).

Guideline and for Nurses and Healthcare Provider for Health Literacy Issue

    In 2010, the NAP was released to provide guidance to nurses and other healthcare professionals regarding improving the current state of low health literacy. The NAP aims direct nurses and other public and private healthcare partners to implement care strategies that keep the health literacy issue at the forefront (Clancy. 2011).Nurses, regardless of their job title or specialty, will always be in a role whereby they can promote and implement the goals of the NAP in addressing health literacy. 

    As Baur (2011) notes, “Nurses see the challenges patients and community members have when they try to make sense of ambiguous preventive health recommendations, unclear medication instructions, dense hospital discharge instructions, jargon filled consent forms, health history, insurance forms, and confusing signage in clinics and hospitals” (p. 64). Nurses must understand the scope and critical need for improving communication and health literacy for every patient.

    The interest in the literacy problem has escalated tremendously in the past 5 to 10 years, and recent results from the PIAAC survey demonstrate that difficulties with literacy, numeracy, and technology use are still prevalent (Rampey et al., 2016). Despite this, PEMs continue to be significantly above the reading level of the general population (Eltorai et al., 2014; McClure et al., 2016; Sudore, Landefeld et al., 2006; Williams et al., 2016). 

    Also, numerous research studies have found the consequences of inadequate literacy and low health literacy are poorer health outcomes, increased hospital re-admissions, and higher healthcare costs (Eichler et al., 2009; McNaughton et al., 2015; Stevens, 2015; Weiss, 2007; Weiss et al., 2005; Wong, 2016; Wu et al., 2016). These out  comes should serve as an incentive for all types of healthcare institutions and insurance payers to develop education programs to better reach patients with different levels of reading ability. 

    Further research to develop and test interventions that would be effective in addressing problems with literacy is warranted. Carollo (2015) examined older women with low health literacy and found that the patient-clinician relationship was an important factor in enhancing communication and empowering the patient, two areas that can positively influence health outcomes. Additional research on the optimal methods for communicating and interacting with diverse groups of people who have limited literacy skills must be explored.

    Some innovative ideas are being used to increase the literacy of children. One such program is READ, which stands for “reading education assistance dogs.” This program brings specially trained dogs to public libraries to provide children with a nonjudgmental audience to read to; almost every state has implemented some type of similar program. These dogs are trained to listen to young readers and detect difficulties with reading. They encourage the child to keep going by providing a gentle nudge or lick on the hand as needed. 

    Children typically respond quite positively to this program and early research finds reading is improved (Hall, Gee, & Mills, 2016; New York Therapy Animals, nd). Similar types of innovative ideas are needed to reach the adult population. Specifically, nursing and healthcare research must focus on nurse client interaction techniques that improve understanding of health information, which would lead to a higher level of motivation and compliance.

    It is not yet well understood if health education materials for clients with low literacy do, in fact, improve health outcomes. In addition, more evidence is needed on the benefits of non print media, such as videos, audiotapes, and computers, in helping clients to overcome barriers of health illiteracy to improve their quality of life. 

    As use of technology becomes increasingly common in health care, the assessment of e-health literacy will become even more important based on the results of the PIAAC international survey that shows people struggling with technology use in problem solving (Rampey et al., 2016).Further, much more attention must be paid to the ethical and legal implications of providing educational materials to clients with limited literacy skills that are suitable to meet those individuals' health information needs. 

    Future research must focus on health literacy to support and understand its role in healthcare reform, as well as better inform nurses of the impact it has on health outcomes (Clancy, 2011). Nurses, in the role of educators, must empirically explore teaching and learning approaches to find those techniques that are most effective in working with clients who suffer the burden of illiteracy and low literacy.

    One major step in the right direction is for nurses to embrace the attitude of “universal precaution” when it comes to literacy. In other words, given the widespread existence of low literacy and the challenges in identifying it, nurses should communicate with every patient as if he or she has difficulty understanding health information (Speros, 2011). 

    This way nurses can promote comprehension of information and minimize the consequences of misunderstanding across all populations. However, they can do this only if they have knowledge about health literacy and interventions to navigate low health literacy. This important topic must be addressed in the curriculum of nursing education (Kennard, 2016; Mc Cleary  Jones, 2016).

Conclusion About Health Literacy Issue and Role of Nurses

    The ability to learn from health instruction varies for clients, depending on such factors as educational background, motivational levels, reading and comprehension skills, and readability level of the materials used for instruction. The prevalence of functional illiteracy and low literacy is a major problem in the adult population of this country.

    Nurses in the role of educators serve as communicators and interpreters of health information. They must always be alert to the potentially limited capacity of their clients to grasp the meaning of written and oral instructions. Nurse educators need to know how to identify clients with literacy problems, assess their needs, and choose appropriate interventions that create a supportive environment directed toward helping those with poor reading and comprehension skills to better and more safely care for themselves. 

    An awareness of the incidence of illiteracy, the populations who are most at risk. and the effects that literacy levels have on motivation and compliance with self management regimens are key to understanding the barriers to communication between nurses and clients.The first half of this chapter focused on the magnitude of the illiteracy problem, the myths and stereotypes associated with poor literacy skills, the assessment of variables affecting reading and comprehension of information, and the readability levels of patient educational materials. 

    The remainder of the chapter examined in detail the measurement tools available to test for readability, comprehension, reading skills, and health literacy: guidelines for writing and evaluating educational materials, and specific teaching strategies to be used to match the logic, language, and experience of clients with literacy problems.

    Data suggest that written materials are an important source of health information to reinforce and complement other methods and tools of instruction. PEMs are the most cost-effective and time efficient means to communicate health messages, but research suggests that there is a large gap between the average comprehension and reading skills of clients and the readability level of current written instructional aids. 

    Unless this gap is narrowed, printed sources of information will serve no useful purpose for adults who suffer with illiteracy and low literacy.Removing the barriers to communication between clients and healthcare providers offers an ideal opportunity for nursing educators to function as facilitators and work collaboratively with other health professionals to improve the quality of care delivered to consumers. It is their mandated responsibility to teach in understandable terms so that clients can fully benefit from interventions.