Why do we have to struggle to further health literacy, when the future of health care seems such an important issue today? Why don’t people just embrace it? Those were the questions that panel member Delores Isham-Colvard, PhD, RN posed in the first presentation of this open session. Jane Krauhs, PhD, moderated the panel of three persons who shared their success stories; in them we find tools for improving our own efforts.
Isham-Colvard, manager of Patient Communication at Children’s Hospital, Dallas, noted that the costs of failing to promote health literacy are high, with communication failures at the root of so many problems, including legal liability, in health care. As far as getting others involved in health literacy, first, she says, “put your face out there.” Get on committees. Here, she told her own “Saga of Pee and Poop” and her experience with her hospital administration who strongly preferred using “urination” or “making water” in brochures. Using words that patients, and especially children, understand is not dumbing down. Writing at the literacy level of most Americans—the 5th or 6th grade level—only makes sense. We should write for our audience.
Shirin Pestonjee, MS, RN, reinforced Isham-Colvard's point. Pestonjee is a patient education specialist at Parkland Health & Hospital System in Dallas. Surveys taken in 1988 and 1998 attest to the success of the Parkland program, which begins with an orientation of new employees. She points out from the very beginning, employees are encouraged to use words that patients understand, like… “pee in the cup,” not “void in the cup.” Many health professionals want to talk at higher reading levels; they are either unaware and can’t grasp the scope of levels, or fear that patients will feel “talked down to.” She gave the example of a fancy packaged system of health information that the employees, after they came to an understanding of literacy levels, rejected—because the reading was at a 12th grade level.
Pestonjee spoke of signs of success of the Parkland orientation program. She gets more calls for advice and direction, a token of increased awareness of literacy levels, and more requests to speak at meetings. Employees now produce more precise documentation. They’ve instituted a “speak up” campaign to get patients to say that they don’t understand, rather than smiling and then going away with incomplete information. Above all, she emphasized, constant attention must be paid to literacy issues, using evidence-based documentation to institute best practices for healthier and happier patients.
Mary Luna-Hollen, PhD, RD, research assistant professor at the University of North Texas Science Center in Fort Worth, described a successful program that uses members of the Spanish-speaking communities to promote health literacy among their friends and neighbors. These Promotores de Salud members are lay people who live in the Spanish barrios; they’ve been trained in a state-certified program. This family and social network approach has proved cost-effective and highly successful: their diabetes prevention program has been shown to bring about a statistically significant decrease in body mass index.
Luna-Hollen noted that the Hispanic population is growing, and at least 32% of this group are uninsured and many live in areas poorly served by the healthcare system. Future success requires universities address the education of community health workers separately from other that of other health care workers. Recruiting more promoters and keeping a pool of certified promoters is one way to insure that we attack the problem of low health literacy in this vulnerable population, she said.
This session will be covered in more detail in a forthcoming issue of the AMWA Journal.
--Mary Wessling
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