Health Literacy and Nursing Education
What Is Health literacy
In
Healthy People 2010, health literacy is defined as, “the degree to which
individuals have the capacity to obtain, process, and understand basic health
information and services needed to make appropriate health decisions (US
Department of Health and Human Services, 2000, Section 11. p. 20).
Implementation of Health literacy
People
with poor literacy skills have much higher medical costs and more
hospitalization than literate people. Poor health literacy results in increased
morbidity and mortality. more emergency department visits, less likelihood of
the use of preventive services, and less likelihood that a person will take
medication as instructed (Bastable, Meyers, & Poitevent , 2014).
Nurses
are in a unique position as patient advocates and educators to help their
clients obtain, process, and understand health information to make appropriate
health decisions (Bastable et al. 2014). Whether in hospitals, long-term
facilities, clinics, or public health settings, nurses provide care to more
than 90 million Americans who struggle to locate, understand, and appropriately
use health information (Zarcadoolas, Pleasant, & Greer, 2006).
The
American Association of Colleges of Nursing (2008) in its Essentials of
Baccalaureate Education for Professional Nursing Practice identifies health
literacy as an important content area for all baccalaureate programs.
“Nurse educators recognize the need for curriculum standards in the area
of health literacy” (Smith & Zsohar, 2011, p. 48).
Nursing education
programs best prepare students by focusing on current health literacy topics
including the definitions of literacy and health literacy, the scope of the
problem, at risk populations, the relationship between health literacy and poor
health outcomes, how to identify people with low literacy skills, e-health
literacy (appraising information from electronic sources), and ways to optimize
the readability of patient education materials.
Plain language communication,
interpersonal skills, cultural sensitivity, at-risk populations, and observed
client behavior related to low literacy are often included in health literacy
education programs (Smith & Zsohar, 2011). Nurse educators can use active
teaching strategies to help students integrate health literacy skills into
practice (Smith & Zsohar, 2011). Nursing students can view video vignettes
and then demonstrate skills. Patient education materials can be tested for
readability and then rewritten at more appropriate reading levels
Research and Health Literacy
Research
in health literacy has focused on the development of standardized tests nurses
can use to measure reading and health literacy skills of patients. These tests
include the Wide Range Achievement Test (WRAT), the Rapid Estimate of Adult
Literacy in Medicine (REALM), the Test of Functional Health Literacy in Adults
(TOFHLA), the Newest Vital Sign (NVS), the eHealth Learning Scale ( eHEALS ),
and the Literacy Assessment of Diabetes (LAD; Bastable et al, 2014). The
dental/medical health literacy screen (REALMD-20) is now available for adult
dental and medical patients (Gironda, Der-Martirosian, Messadi, Holtzman, &
Atchison, 2013).
Administration
of health literacy screening tests can be awkward for nurses to use in practice
and the results can be hard to use. According to Chew, Bradley, and Boyko
(2004), an easier way to identify inadequate health literacy skills is to ask
three questions:
(a) “How often do you have someone help you read hospital
materials?”
(b) “How confident are you filling out medical forms by
yourself?”
(c) “How often do you have problems learning about
your medical condition because of difficulty understanding written
information?”
Bastable
et al. (2014) summarize the literature and present practical strategies for
nurses to use when in the role of an educator. These strategies include
establishing a trusting relationship before starting the learning process,
using the smallest amount of information to accomplish behavioral objectives,
teaching one step at a time, using multiple methods and tools requiring fewer
literacy skills, allowing patients the opportunity to restate information in
their own words and demonstrating procedures, recognizing patient progress to
keep motivation high, tailoring new regimens into daily schedules of clients,
and utilizing repetition by saying the same thing in different ways.
Nurses
often rely on the classic work of Doak, Doak, and Root (1996) for ideas on
preparing written materials, Bastable et al. (2014) consolidate the literature
and provide a comprehensive list of 27 strategies to use in writing
easy-to-read patient education materials. Suggestions include ideas on text and
sentence construction, format, layout, and the use of graphics.
Specific
writing ideas include the following: use conversational style, use short words,
use headers, have sufficient white space, use short sentences, define technical
words, use simple and realistic drawings, use simple type style at 14 to 16
font size, and aim at or less than the 6th grade reading level. In addition,
all written materials should be read ability tested using a formula such as
SMOG (estimate of the years of education a person needs to understand written
material) or FRY (evaluates readability) and be pretested.
Role of Faculty In Nursing Health Literacy
The
role of an educator has always been an important part of nursing practice.
Nurses are communicators and interpreters of health information. As stated by
Bastable et al. (2014). “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” (p. 303 ).
Nurses
are in the ideal position to improve the quality of care delivered to clients.
As the health care system becomes increasingly diverse and populations more
heterogeneous, it becomes critical for nurses to learn and implement health
literacy concepts and skills to help clients with the many problems associated
with poor health literacy.