Compassionate communication starts with making information as easy to understand as possible. Health Literacy is an individual's ability to find, understand, and use health information and services to make health-related decisions and take health-related actions (personal health literacy). It is a function of a person's education, literacy skills, numeracy skills, and their ability to navigate the health care system. Health literacy also includes how well an organization equitably enables individuals to find, understand, and use information and services for health-related purposes (organizational health literacy).
Health Literacy Basics
In the U.S., 36% of adults have basic or below-basic health literacy skills; only 12% have proficient skills at baseline. Basic and below basic health literacy is considered inadequate for fully benefiting from health information the way it is usually shared by health care professionals in spoken conversations and written materials. Everyone's baseline health literacy skills can go down during times of stress (feeling ill, in pain, worried, or tired) when the ability to understand and act on health information is needed most. People of all socioeconomic backgrounds can experience low health literacy. On average, however, American Indian and Alaska Native-, Black-, and Hispanic-identifying individuals experience lower health literacy rates than Asian/Pacific Islander and non-Hispanic White-identifying individuals, due to educational inequities. People who learned English as a second or other language may also struggle with lower health literacy, and people over age 65 have significantly lower average health literacy than people who are younger.
Health literacy is a social determinant of health which affects a wide array of health-related outcomes, such as receiving routine preventive care, understanding information about diagnoses and management of chronic illness, understanding and taking medication correctly, preventable use of emergency services, hospital admission and readmission rates, overall mortality rates, and racial and ethnic health care inequities and health disparities.
Best Practices for Clear Communication
Clinicians and medical trainees often and unintentionally make health information and communication overly complex and difficult to understand for patients and caregivers.
It is the responsibility of health care professionals, and their organizations and training programs, to address health literacy-related issues and inequities by promoting and practicing clear communication strategies.
Fortunately, there are a number of clear communication best practices that can be used to improve health literacy-related inequities and health outcomes for everyone.
People of all educational and health literacy levels prefer health information presented in its simplest, easiest-to-understand form. Health professionals are often unaware of how well patients and caregivers are understanding them. A "universal precautions" approach to health communication means making information as easy as possible to understand and act on for all patients and caregivers at all points of contact. Don't assume a person's health literacy level, even for people you believe will have a high-level of understanding. Instead, use these clear communication techniques for everyone.
Unnecessary and undefined medical jargon can undermine a person's understanding, confidence, trust, and ability to act on health information. Speak and write using "plain language"—words and phrases that people without health professions training will recognize and use in their daily lives. When using medical terms is necessary, make sure to define or describe their meaning and check patients' understanding.
When it comes to health information and clear communication, less is often more. To avoid information overload, prioritize sharing high-priority "need-to-know" information first before anything else. Focus on the 1 to 3 "need-to-know" things you want the patient or caregiver to understand and remember after the encounter. Sharing this information in a logical order will help with patient understanding and recall.
Make sure to check the patient's understanding of each point before moving on to the next item. Providing additional information past the main points should be matched to the patient or caregiver's request for more information.
When asking patients or caregivers questions to check for understanding or to address concerns, avoid using questions that have a "yes" or "no" response. Asking open-ended questions will allow you to be more successful in evaluating their understanding of information or in eliciting their concerns.
For example, instead of asking "Do you have any questions?" try asking "What questions do you have?"
Health care professionals should always check that they have communicated clearly. Unfortunately, for complex reasons, asking patient and caregivers "yes" or "no" questions are often answered misleadingly. Questions like, do you understand? or, does this make sense? and do we have a good plan? are often answered with a "yes", even when there is significant confusion or misunderstanding.
Instead, the teach-back technique allows you to elicit a patient's understanding of the information you've shared in their own words. When using this method, be sure to tell them you are checking to see how well you did in explaining things; do not make it seem like you are testing them.
Try using phrases such as:
"Let me make sure I've explained things clearly. In your own words, what is the plan?"
"I want to make sure I described this well, can you tell me how you'll use the new device?"
"How would you explain this to your partner?"
On average, baseline health literacy is lower among adults who learned English as a second or other language. For such individuals, the use of unnecessary medical jargon may be even more problematic. Communicating in a patient or caregiver's preferred language, using medical interpreters, and using clear communication principles will provide the best potential benefit in medical encounters. Health care organizations should also work with translation services to provide written materials in languages used by their patient populations.
Keep in mind that not all patients prefer the same method of communication for a variety of reasons. Some patients may prefer written communication and would benefit from handouts to supplement information shared verbally. Others may have a difficult time with heavy reading and prefer a verbal conversation or watching a video they can listen to and replay when needed. Having multiple methods for sharing common need-to-know information helps cultivate equitable access to health information and sources. Written materials should also be produced at a 5th to 6th grade reading level, in order to be accessible to the majority of U.S. adults.
Training for Working Professionals
Health literacy and clear communication are cross-cutting themes with broad interest across professions. Health literacy training benefits many different health care professionals, medical disciplines, health systems, and coordinated care organizations. Viewing different topics through a health literacy lens allows professionals to gain new perspectives into patient decision making and helps them better understand the patient experience.
In our goal to expand health literacy training throughout OHSU and the state, we aim to share information about the fundamentals of health literacy, give presentations tailored to specific programs' needs, and offer feedback on curriculum development. Recent health literacy trainings have included topics such as ageism in health care, systemic racism in health care, vaccine hesitancy, diabetes education, and caring for people with disabilities. For more information, please contact the Center for Ethics.