Nursing Education and Health Literacy

Nursing Education and Health Literacy What Is Health Literacy?

Health literacy, as defined by “Healthy People 2010,” refers to “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (U.S. Department of Health and Human Services, 2000, Section 11, p. 20). In other words, health literacy encompasses the skills necessary for people to comprehend and act on medical instructions, understand medication labels, follow health advice, and make informed decisions about their health.

Implementation of Health Literacy

Poor health literacy has profound implications for both individual patients and the healthcare system as a whole. People with limited literacy skills incur significantly higher medical costs and experience more frequent hospitalizations than those with adequate literacy abilities. Poor health literacy contributes to increased morbidity and mortality, more emergency department visits, reduced use of preventive services, and decreased adherence to prescribed medication regimens (Bastable, Meyers, & Poitevent, 2014).

Nurses play a crucial role in promoting health literacy as patient advocates and educators. They are often at the forefront of patient care, working in hospitals, long-term care facilities, clinics, and public health settings. In these roles, nurses serve more than 90 million Americans who struggle to find, understand, and appropriately use health information (Zarcadoolas, Pleasant, & Greer, 2006).

The American Association of Colleges of Nursing (AACN) (2008) emphasizes the importance of health literacy in its Essentials of Baccalaureate Education for Professional Nursing Practice. Health literacy is considered a critical content area for all baccalaureate nursing programs. “Nurse educators recognize the need for curriculum standards in the area of health literacy” (Smith & Zsohar, 2011, p. 48).

To prepare nursing students effectively, education programs must focus on various health literacy topics, including:

1. Definitions of Literacy and Health Literacy: Understanding the difference between general literacy (the ability to read and write) and health literacy (the capacity to comprehend health information).
2. Scope of the Problem: Recognizing the widespread nature of health literacy challenges and their impact on health outcomes.
3. At-Risk Populations: Identifying groups most vulnerable to low health literacy, such as older adults, non-native speakers, and those with low socioeconomic status.
4. Relationship Between Health Literacy and Poor Health Outcomes: Examining how low health literacy contributes to poorer health outcomes and higher healthcare costs.
5. Identifying People with Low Literacy Skills: Learning methods to assess and identify individuals with limited health literacy.
6. E-Health Literacy: Developing the ability to evaluate and use information from electronic sources.
7. Optimizing the Readability of Patient Education Materials: Creating and assessing materials that are understandable to individuals with varying levels of literacy.

Health literacy education also includes training in plain language communication, cultural sensitivity, interpersonal skills, and recognizing client behavior related to low literacy. These skills are crucial for nurse educators, who can use active teaching strategies, such as role-playing and case studies, to help students integrate health literacy skills into practice (Smith & Zsohar, 2011). Additionally, nursing students can watch video vignettes, practice with real-world scenarios, and rewrite patient education materials to more suitable reading levels.

Research and Health Literacy

Research in health literacy has focused on developing standardized tests that nurses can use to measure the reading and health literacy skills of patients. Some of these tests include:

• Wide Range Achievement Test (WRAT)
• Rapid Estimate of Adult Literacy in Medicine (REALM)
• Test of Functional Health Literacy in Adults (TOFHLA)
• Newest Vital Sign (NVS)
• eHealth Learning Scale (eHEALS)
• Literacy Assessment of Diabetes (LAD) (Bastable et al., 2014)

Additionally, the dental/medical health literacy screen (REALMD-20) is available for use with adult dental and medical patients (Gironda, Der-Martirosian, Messadi, Holtzman, & Atchison, 2013).

Despite the availability of these tools, administering health literacy screening tests can be awkward for nurses in practice, and the results may be challenging to interpret and use effectively. Chew, Bradley, and Boyko (2004) suggest a simpler method to identify inadequate health literacy skills by asking patients three straightforward questions:

1. “How often do you have someone help you read hospital materials?”
2. “How confident are you in filling out medical forms by yourself?”
3. “How often do you have problems learning about your medical condition because of difficulty understanding written information?”

These questions are more practical for clinical settings and can help quickly identify patients who may need additional support.

Bastable et al. (2014) also summarize several practical strategies for nurses to use when acting as educators, including:

• Establishing a trusting relationship before beginning the teaching process.
• Using minimal information to achieve specific behavioral objectives.
• Teaching one step at a time.
• Using multiple methods and tools that require fewer literacy skills.
• Allowing patients to restate information in their own words and demonstrate understanding of procedures.
• Recognizing patient progress to maintain motivation.
• Tailoring new health regimens to fit into the daily schedules of clients.
• Repeating important information using different methods and formats.

When preparing written materials, nurses often rely on the classic work of Doak, Doak, and Root (1996) for guidance. Bastable et al. (2014) provide a consolidated list of 27 strategies for writing easy-to-read patient education materials, focusing on text and sentence construction, format, layout, and graphics. For instance, they suggest using a conversational style, short words, headers, sufficient white space, simple and realistic drawings, and a readable font size of 14 to 16 points, aiming for materials at or below a 6th-grade reading level. All materials should be tested for readability using formulas like SMOG (Simple Measure of Gobbledygook) or FRY (a readability formula) and should be pre-tested with the target audience.

Role of Faculty in Nursing Health Literacy

The role of an educator has always been a core component of nursing practice. Nurses act as communicators and interpreters of health information. According to 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 a unique position to improve the quality of care provided to patients. As the healthcare system becomes more diverse and populations grow more heterogeneous, it is increasingly crucial for nurses to learn and implement health literacy concepts and skills to help clients navigate the challenges associated with poor health literacy.

Faculty in nursing education programs must prioritize teaching health literacy by integrating these skills into the curriculum. Faculty should employ various teaching strategies, such as simulations, role-playing, and case studies, to help students apply health literacy principles in real-world situations. Moreover, they should encourage students to develop cultural competence and sensitivity, ensuring they can communicate effectively with patients from diverse backgrounds.

Faculty must also stay updated on the latest research in health literacy and be prepared to incorporate new findings into their teaching. This continuous learning process will enable faculty to provide the most relevant and practical education to their students, preparing them to be effective health educators in their future careers.

Research and Health Literacy: The Need for Ongoing Study

Despite advancements in understanding health literacy, there is still much to learn. Research must continue to develop new tools and strategies that are both effective and easy for healthcare providers to use. More studies are needed to identify the best methods for integrating health literacy into nursing curricula and to evaluate the impact of these methods on patient outcomes.

Additionally, research should focus on developing innovative approaches to improve health literacy among vulnerable populations. These studies could explore the effectiveness of different communication techniques, digital tools, and community-based interventions in enhancing health literacy and reducing health disparities.

Finally, it is essential to investigate the role of technology in health literacy. As more health information becomes available online, it is crucial to understand how to help patients navigate digital resources safely and effectively. Research in e-health literacy, or the ability to find, evaluate, and use health information from electronic sources, will become increasingly important in the digital age.

Conclusion

Health literacy is a critical component of nursing education that significantly impacts patient care and outcomes. Nurses, as educators and advocates, play a vital role in helping patients understand and use health information effectively. By integrating health literacy into nursing curricula, employing practical strategies for teaching, and staying informed about the latest research, nurse educators can prepare their students to meet the challenges of healthcare delivery in a diverse and evolving environment.

As the healthcare landscape continues to change, health literacy will remain an essential skill for nurses at all levels. By fostering these skills in future nurses, nursing education programs can help ensure that patients receive the highest quality care, regardless of their literacy levels.