Promotion of Health Literacy and Strategies In Nursing Education

Strategies In Nursing Education to Promotion of Health Literacy

Whats are Teaching Strategies to Promote Health Literacy,Suggested Teaching Strategies to Promote Health Literacy:Development of Teaching Relationship,Concise and Useful Information,Simple and Concrete Explanation,Step by Step Information,Multiple Teaching Methods,Self Explanation for Feedback,Overcome the Fear of Failure of Learner,Make a Coordination,Reinforcing the Information,Outcomes of Teaching Strategies In Nursing .

Whats are Teaching Strategies to Promote Health Literacy

    Working with clients who are illiterate and marginally literate requires more than just designing simple-to-read instructional literature. It also calls for using alternative and innovative teaching strategies to break down the barriers of illiteracy. Using techniques to improve communication with clients has the potential to greatly enhance their understanding (Brega et al., 2015; Weiss, 2007).

    Further, teaching clients with poor reading skills does not have to be viewed as a problem but rather as a challenge (Dunn, Buckwalter, Weinstein, & Palti, 1985). Existing teaching methods and tools can be adapted to match the logic, language, and experience of the patient who has difficulty with reading and comprehension (Doak et al., 1998). Incidentally, many literates and highly motivated clients also can benefit from some of these same teaching strategies.

Suggested Teaching Strategies to Promote Health Literacy

    Many authors suggest the following tips as useful strategies for the nurse to employ when acting in the role of educator (Brega et al., 2015; Carollo, 2015; Doak et al., 1998; Fidyk, Ventura, & Green, 2014; Hyde & Krautz, 2014; Kemp, Floyd, McCord Duncan, & Lang, 2008; Kessels, 2003; Lerner et al., 2000; Pignone et al., 2005; Rothman et al., 2004; Ryan et al., 2014; Schultz, 2002; Weiss, 2007; Winslow, 2001):

Development of Teaching Relationship

    Establish a trusting relationship before beginning the teaching learning process. Start by getting to know the clients to reduce their anxiety. Because many poor readers have a history of being defensive, the nurse educator must attempt to overcome their defense mechanisms by casting aside communication barriers such as any preconceived notions, including myths and stereotypes. So, focus on clients' strengths. 

    Demonstrate your belief in them as responsible individuals. Be open and honest about what specifically needs to be learned to build their confidence in their ability to perform self care activities. Encourage family and friends to help reinforce the clients' self confidence.

Concise and Useful Information 

    Use the smallest amount of information possible to accomplish the predetermined behavioral objectives. Stick to the essentials, paring down the information you teach to what the client must learn. Prioritize behavioral objectives, and select only one or two concepts to present and discuss in any one session. Present the context of the message first before giving any new information. 

    Remember, clients with poor comprehension and reading skills are easily overwhelmed. Information about the history of treatment, general principles, statistics, detailed physiology, and extraneous facts about a topic are not necessary for them to know. Keep teaching sessions short, limiting them to no more than 20 to 30 minutes; 15 to 20 minutes is the ideal time limit.

Simple and Concrete Explanation

    Make points of information as vivid and explicit as possible. Explain information in simple, concrete terms using everyday, living-room language. Provide personal examples relevant to the client's background. Visual aids, such as signs and pictographs, should be large with readable print and contain only one or two messages. For example, a sign saying “NOTHING BY MOUTH” or. worse yet. “NPO” should be changed to “Do not eat or drink anything” (remember to avoid using all capital letters and abbreviations).

    Underlining, highlighting, color coding, arrows, and common international symbols can be used effectively to give directions and draw attention to important information. For example, different colored signs, pictorial cues, and other visual stimuli, such as strips on the floor tiles that lead to specific areas of the hospital, are valuable for increasing independence and safety.

Step by Step Information

    one step at a time. Teaching in increments and organizing information into segments of information (chunks) help to reduce anxiety and confusion and give enough time for clients to understand each item before proceeding to the next unit of information. Also, these techniques give clients a sense of order and a chance to ask questions after each block of information has been presented. Most important, the pacing of instruction allows for more adequate time between sessions for learners to assimilate information.

Multiple Teaching Methods 

    Use multiple teaching methods and instructional tools requiring fewer literacy skills. Oral instruction contains cues such as tone, gestures, and expressions that are not found in written materials. However, the spoken word lacks other signals, such as punctuation and capital letters. Consequently, a person with poor reading skills is likely to have some trouble with understanding spoken language as well. 

    The listening test. as previously described, can be used to measure comprehension of oral instruction. Another way to test the difficulty level of information presented verbally is to begin by taping a spoken message, converting it into a written form, and then applying a readability formula to it.

    Exposing clients to repetition and multiple forms of the same message is highly recommended. Audiotaped instruction, used in combination with other visual resources such as simple lists, pictures, and videotapes, can help to improve comprehension and reduce learning time. These media forms, as more permanent sources of information, can be sent home with the client for added reinforcement of health messages. 

    Also, interactive computer programs, which allow clients to proceed at their own pace, can be programmed developmentally to match a user's literacy skill level. Allow patients the chance to restore information in their own words and to demonstrate any procedures being taught. Use the teach-back or “show me” method to verify that information shared with the learner was, in fact, understood.

Self Explanation for Feedback

    Encouraging learners to explain something in their own words may take longer and requires patience on the part of the educator, but feedback in this manner can reveal gaps in knowledge or misconceptions of information. Return demonstration, hands on practice, role playing real life situations, and sharing personal stories in dialogue form are communication modes that provide you with feedback about the patient's level of functioning.

    Trying to elicit feedback by asking questions does not always work because people with low literacy skills often do not have the right vocabulary or fluency to explain what they do and do not understand. Remember, do not ask questions that will only elicit a “yes” or “no” response. Learners will likely respond in the affirmative, even when they have no clue as to what the nurse educator is talking about, just so they do not have to admit their ignorance.

    Furthermore, learners with low literacy skills are unlikely to ask questions of the educator for fear of embarrassment at not understanding instructions. Use open-ended statements, such as “Tell me what you understand about to obtain feedback from them to verify their comprehension. Encouraging clients to repeat instructions in their own words or physically demonstrate an activity is an effective approach to verifying what they really understand.

    Chew et al. (2004) developed three questions as a practical and quick method for identifying literacy skills in patients: 

(1) “How often do you have someone help you read hospital materials?” 

(2) “How confident are you filling out medical forms by yourself?”

(3) “How often do you have problems learning about your medical condition because of difficulty understanding written information?” 

    They found these three questions to be effective screening tests for inadequate health literacy in patients at a Veterans Administration preoperative clinic but not as effective for detecting patients with marginal health literacy.

Overcome the Fear of Failure of Learner 

    Keep motivation high. It is important to recognize that people with limited literacy may feel like failures when they cannot work through a problem. Reassure them that it is normal to have trouble with new information and that they are doing well. Encouraging them to keep trying and recognizing any progress they make, even if it occurs only in small increments, is motivating to the slow learner. 

    Rewards not punishments-are excellent motivators. Sticking to the basics and keeping the information relevant and succinct will maintain a learner's interest and willingness to learn.

Make a Coordination

   Build in coordination of procedures. A way to facilitate learning is to simplify information by using the principles of tailoring and cuing. Tailoring refers to coordinating recommended regimens into the daily schedules of clients rather than forcing them to adjust their life styles to these regimens. Otherwise. clients may feel that changes are being imposed on them. Tailoring allows new tasks to be associated with old behaviors. 

    It personalizes the message so that instruction is individualized to meet the client's learning needs. For example, coordinating a medication schedule to a patient's mealtimes does not dramatically alter everyday lifestyle and tends to increase motivation and compliance. 

    Cuing focuses on the appropriate combination of time and situation using prompts and reminders to get a person to perform a routine task. For example, placing medications where they best can be seen on a frequent basis or keeping a simple chart to check off each time a pill is taken serves as a reminder to comply with taking medications as prescribed.

Reinforcing the Information

    Use repetition to reinforce information. Repetition, at appropriate intervals, is a key strategy to use with clients who have low literacy. Each major point made along the way should be reviewed. Therefore, time must be set aside to remind learners of what has come before and to prepare them for what is to follow. This is time well spent repetition, in the form of saying the same thing in different ways, is one of the most powerful tools to help clients understand their situations and learn important self-care measures.

Outcomes of Teaching Strategies In Nursing 

    These teaching strategies are especially well suited to the individual needs of people with low literacy skills. As noted earlier, nurses must empower consumers by providing health information that is culturally and linguistically appropriate. Creating an open, trusting, and accepting environment that makes it acceptable for the client to say, “I don't understand,” is the cornerstone of effective communication (Carollo, 2015; Cole, 2000).

    It is always a challenge to teach clients who, because of illness or a threat to their well-being, may be anxious, frightened, depressed, in denial, or in pain. Teaching patients is even more of a special challenge in today's healthcare environment, when varying degrees of literacy compound the ability of a significant portion of the adult population to understand information vital to their health and welfare.