Health Literacy 101/ Teach-Back – Flashcards
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What is the teach back method?
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Asking patients to repeat in their own words what they need to know or do, in a non-shaming way
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What is teach back a test of?
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NOT a test of the patient, but of how well you explained a concept
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What does teach back allow for?
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A chance to check for understanding and, if necessary re-teach information
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What populations should you use the teach back method with that are at risk?
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Elderly, Ethnic/Racial minorities, Persons with limited education, Persons of low socioeconomic status, Person with chronic disease
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Which clinical setting can teach back be used?
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Clinic, Home health, Hospital
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What does the teach back method replace?
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Replaces the more common practice of asking "Do you understand" and limits the patient from answering "yes" when they understand nothing
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Teach back in evidence based practice
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Increase in glycemic control in diabetic patients and now considered top 11 patient safety practices
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Why should a provider implement the teach back method?
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Provides opportunity to check understanding and reteach if necessary... 1. Re-phrase If patient is not able to repeat info correctly 2. ask patient to repeat info until you feel comfortable they understand 3. If still don't understand use pictures, videos, analogies
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How should a provider use teach-back?
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Ask patients to demonstrate understanding: - "what will you tell your spouse about the condition?" -"show me what you would do" -"I want to be clear I taught the information correctly, can you explain it back to me" DO NOT ASK "DO YOU UNDERSTAND" Chunk and Check information - summarize and check for understanding throughout not at the end
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Considerations for the provider with teach-back?
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Slow down Use a caring tone of voice/attitude Use plain language Use short statements Focus on 2 or 3 important concepts
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What can the teach-back method help reduce?
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medication errors and mistakes with care instructions
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Who should the teach back method be used on?
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ALL patients
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Could teach back work in non-clinical settings?
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yes, this would work for scheduling follow-up appointments, following directions to get to the lab or radiology departments, understanding health insurance information
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What is literacy?
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Using printed and written information to function in society, achieve ones goals, and develop ones knowledge and potential
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What is health literacy?
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The degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions
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What is the patient's ability of health literacy?
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obtain, understand, and act on health information
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What is the providers ability of health literacy?
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Communicate clearly, educate about health and empower their patients
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What does health literacy impact?
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Access, Safety, Quality, and Outcomes
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What skills does literacy represent?
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reading, writing, basic mathematical calculations, listening, speaking and cultural and conceptual knowledge.
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How does health literacy impact access?
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Health care information is often difficult to find. Which websites do you use? Which care do you need? How do you know when to seek out or why you need preventive care? What about navigation? Where do I go once I get there? (maps, numeracy, bus schedules).
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How does quality impact health literacy?
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Patients who have trouble understanding their doctor's instructions often report lower satisfaction with their clinic. Health professionals also need to pay attention to cultural and linguistic needs of each patient.
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How does safety impact health literacy?
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Patients with low health literacy may not be able to clearly report about their condition and/or medication, this can be dangerous if treatment is based on inaccurate self-reports, may not understand informed consent, and may be nervous to report they don't understand
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How does outcomes impact health literacy?
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Low health literacy impacts understanding of medication labels and treatment regimens, overall treatment adherence problems arise when patients don't understand the importance of maintaining a treatment course or follow-up appointments.
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What percentage of adult persons are proficient?
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12%
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What are some examples of each health literacy task at each level?
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Below Basic: circle date on doctor's appointment slip Basic: give 2 reasons a person with no symptoms should get tested for cancer based on a clearly written pamphlet Intermediate: determine what time to take prescription medicine based on label Proficient: calculate employee share of health insurance costs using table
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Why are patients more at risk for problems with health literacy?
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Provider reliance on the written word for patient instruction
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At which grade level are most health instructions written?
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12th grade
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At what grade level does the average adult understand?
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8th grade
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What is the second risk for problems with health literacy?
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Increasingly complex health care system: More medications More tests and procedures Growing self-care requirements Esoteric language
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Why do more medications, tests, and procedures put patients at risk for problems?
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Patients are expected to choose between different tests and procedures along with manage care on their own (self-care)
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What percentage of people don't use the internet to understand health issues?
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80% of people never do
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Populations at risk for low health literacy?
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Elderly Ethnic and racial minorities Limited education Immigrants Low socioeconomic status People with chronic disease
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Which age group is the most at risk for not understanding health information?
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Elders aged 65 years and older
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Why are elders most at risk with health information?
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Physical limitations - poor eyesight and/or hearing, memory problems Passive learning style - learn more from TV, watching...whatever comes by them, rather than pursuing knowledge through reading Living longer with complicated illnesses & increased self-care requirements Perhaps they grew up in a time where questioning the doctor was not considered ok
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What have studies shown about elderly patients in regards to medication?
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Report non-adherence to medication, do not take medications as directed, and have 3 or > chronic disease
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Which race/ethnicity Is most at risk for health literacy related complications?
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Hispanics
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How often are patients with low health literacy hospitalized?
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twice as often- and results in longer hospital stays
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Why are patients with low health literacy hospitalized more often?
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Patients don't understand treatment regimens &/or the importance of following them, so they make medication errors Patients present at later stages of illness- wait until symptoms are advanced to seek help They use the emergency department more often
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What is the burden of low health literacy on the health care system?
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Low health literacy increases US health care costs by $50 billion - $73 billion annually.*
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Why are low health literacy levels so costly?
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longer hospital stays, medication errors, excess hospitalizations, more use of the emergency department and higher level of illness.
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Who pays for the costs of low health literacy?
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We all do
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What do we know about health literacy?
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We know that low health literacy is a universal problem - that anyone can have trouble understanding health information and that everyone struggles when hearing a new diagnosis. We know that health literacy is one of the best predictors of health status, regardless of race, socioeconomic level, etc. That lower health knowledge leads to less healthy behaviors, increasing costs, and leading to poorer health outcomes.
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What are some red flags to low health literacy?
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Making excuses- "I forgot my glasses", "Let me bring it home to discuss it with my spouse" Perceived resistance- frustrated Has no questions Frequently missed appointments, tests- to physician, or not refilling prescriptions Non-adherent with meds or treatment- brown paper bag test (unable to name medications/how they use them), wait until sick to go to ER, incomplete forms
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What are some ways to convey helpfulness and non-shamefulness with low health literacy patients?
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Ask open ended questions Remember to smile Listen without interruption Encourage questions and patients to speak up Take responsibility for communication breakdowns- "I didn't explain that well" Provide help confidentially not in waiting room
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What are strategies to improve intrapersonal communication?
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Slow down and use plain language not medical jargon called "living room language" Use analogies and pictures for visual learners- analogies need to make sense to patient "cant talk about ocean if never seen one before" List 1-3 important concepts Repeat them
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How to evaluate which information to teach a patient?
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Evaluate what the patient already knows about the condition and pick 1-3 important concepts
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Why was ask me 3 designed?
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It was written to help encourage patients to be active in their visits and empower them to be sure they know the answers to the three questions at the end of every visit/conversations/ etc. with a health care professional.
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Which questions are involved in ask me 3?
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What is my main problem? (Diagnosis) What do I need to do? (Treatment) Why is it important to do this? (Context)
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What are some tips for easy to understand materials?
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Keep text short and simple- size 12 font, Times new roman Limit medical jargon Use clear headings, bullets and lots of white space Use active voice- " the dog bit me" instead of "The boy got bit by the dog" Focus only on 1-3 key points Emphasize what the patient should do (actions) Use of simple pictures - many translate to across languages Sensitive to cultural preferences Follow-up-->Teach back method
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What next steps can you make for low health literacy?
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Apply strategies Do a walk-through in your area and identify barriers Review documents and forms and simplify as appropriate Develop a plan to educate all staff about health literacy
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T or F; Literate patients are insulted by low literacy materials.
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False. Everyone appreciates easy to understand information about their health. We all feel "health illiterate" when hearing a new diagnosis
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T or F; You can tell by looking if someone has low health literacy.
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False. You can't tell. Health Literacy is a universal problem.
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T or F; A college degree means the patient will understand medical information.
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False. On average people read 3 to 5 grades lower than the last year of school completed.
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T or F; Many of my patients have problems understanding health information.
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True, only 12% of adult population are proficient
