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    3 steps to boost health literacy

    What do patients and their families really understand about their healthcare and what can pediatricians do about it?

     

    3.  Use plain language. Something can be said to be written in plain language when information is understood the first time it is read or heard. A plain language document allows patients and parents to find needed information, understand the information, and take appropriate action.27

    When developing or evaluating materials for patients and parents in your practice, you will want to ask yourself several questions:28

    ·      Who is my audience?

    ·      What is my purpose?

    ·      What is my message?

    ·      How urgent is my message?

    ·      What is the “need to know and do”?

    Key components for materials include:29,30

    ·      Placing the most important points first.

    ·      Chunking information or breaking complex topics into understandable chunks.

    ·      Using simple, living-room language rather than technical language.

    ·      Making sure your document answers questions that your parents and patients have about a particular topic.

    ·      If you need to use technical language, make sure to provide a definition.

    ·      Using the active voice. Active voice makes it clear who needs to take action.

    ·      Writing in the first or second person when possible.

    ·      Shorter is better. Not just total length, but paragraphs of 5 sentences with each sentence containing 10 to 20 words is optimal.

    ·      If you can use a picture, table, or illustration instead of a paragraph, that is optimal.

    ·      Using easy-to-read fonts and having plenty of white space.

    ·      Making your document skimmable by using headings and numbered or bulleted lists.

    Summary

    Health literacy cannot be seen, but the pediatrician should assume patients and parents in his or her practice have issues with health literacy. Small changes in communication, developing materials, and addressing how patients are instructed to take medications can make the difference in whether or not patients follow instructions and take their medication correctly. In addition, the pediatrician should consider advocacy to promote health literacy in his or her hospital and community.

    Next: Office preparedness for childhood for emergencies

    REFERENCES

    1. Anderson JL, Dodman S, Kopelman M, Fleming A. Patient information recall in a rheumatology clinic. Rheumatol Rehabil. 1979;18(1):18-22.

    2. Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96(5):219-222.

    3. Turner T, Cull WL, Bayldon B, et al. Pediatricians and health literacy: descriptive results from a national survey. Pediatrics. 2009;124 suppl 3:S299-S305.

    4. Institute of Medicine (US) Committee on Health Literacy; Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.

    5. Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002;40(5):395-404.

    6. MacLeod S, Musich S, Gulyas S, et al. The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults. Geriatr Nurs. 2017;38(4):334-341.

    7. Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003;51(3):267-275.

    8. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;114(4):1008-1015.

    9. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998;158(2):166-172.

    10. Lai AY, Ishikawa H, Kiuchi T, Mooppil N, Griva K. Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis. Patient Educ Couns. 2013;91(2):221-227.

    11. Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83-90.

    12. DeWalt DA, Dilling MH, Rosenthal MS, Pignone MP. Low parental literacy is associated with worse asthma care measures in children. Ambul Pediatr. 2007;7(1):25-31.

    13. Harrington KF, Zhang B, Magruder T, Bailey WC, Gerald LB. The impact of parent's health literacy on pediatric asthma outcomes. Pediatr Allergy Immunol Pulmonol. 2015;28(1):20-26.

    14. Ross LA, Frier BM, Kelnar CJ, Deary IJ. Child and parental mental ability and glycaemic control in children with Type 1 diabetes. Diabet Med. 2001;18(5):364-369.

    15. Yin HS, Dreyer BP, Foltin G, van Schaick L, Mendelsohn AL. Association of low caregiver health literacy with reported use of nonstandardized dosing instruments and lack of knowledge of weight-based dosing. Ambul Pediatr. 2007;7(4):292-298.

    16. DeWalt DA, Hink A. Health literacy and child health outcomes: a systematic review of the literature. Pediatrics. 2009;124 suppl 3:S265-S274.

    17. Herman A, Jackson P. Empowering low-income parents with skills to reduce excess pediatric emergency room and clinic visits through a tailored low literacy training intervention. J Health Commun. 2010;15(8):895-910.

    18. Yin HS, Mendelsohn AL, Wolf MS, et al. Parents' medication administration errors: role of dosing instruments and health literacy. Arch Pediatr Adolesc Med. 2010;164(2):181-186.

    19. Yin HS, Dreyer BP, Moreira HA, et al. Liquid medication dosing errors in children: role of provider counseling strategies. Acad Pediatr. 2014;14(3):262-270.

    20. Yin HS, Dreyer BP, van Schaick L, Foltin GL, Dinglas C, Mendelsohn AL. Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch Pediatr Adolesc Med. 2008;162(9):814-822.

    21. Rogers ES, Wallace LS, Weiss BD. Misperceptions of medical understanding in low-literacy patients: implications for cancer prevention. Cancer Control. 2006;13(3):225-229.

    22. Graham S, Brookey J. Do patients understand? Perm J. 2008;12(3):67-69.

    23. Kornburger C, Gibson C, Sadowski S, Maletta K, Klingbeil C. Using “teach-back” to promote a safe transition from hospital to home: an evidence-based approach to improving the discharge process. J Pediatr Nurs. 2013;28(3):282-291.

    24. Badaczewski A, Bauman LJ, Blank AE, et al. Relationship between Teach-back and patient-centered communication in primary care pediatric encounters. Patient Educ Couns. 2017;100(7):1345-1352.

    25. Mallory LA, Diminick NP, Bourque JP, et al. Pediatric patient-centered transitions from hospital to home: improving the discharge medication process. Hosp Pediatr. 2017;7(12):723-730.

    26. Gould JM, Hennessey P, Kiernan A, Safier S, Herman M. A novel prevention bundle to reduce surgical site infections in pediatric spinal fusion patients. Infect Control Hosp Epidemiol. 2016;37(5):527-534.

    27. Plain Language Action and Information Network. What is plain language? Available at: https://www.plainlanguage.gov/about/definitions/. Accessed December 11, 2017.

    28. National Institutes of Health. Plain language: Before you start writing. Available at: https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/plain-language/before-you-start-writing. Published March 27, 2017. Accessed December 11, 2017.

    29. Doak CC, Doak LG, Root JH. Teaching Patients with Low Literacy Skills. 2nd ed. Philadelphia, PA: J.B. Lippincott Co.; 1996.

    30. Doak CC, Doak LG, Friedell GH, Meade CD. Improving comprehension for cancer patients with low literacy skills: strategies for clinicians. CA Cancer J Clin. 1998;48(3):151-162.

    Pat F Bass III, MD, MS, MPH
    Dr Bass is Chief Medical Information officer and professor of Medicine and of Pediatrics, Louisiana State University Health Sciences ...

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