Tuesday, July 28, 2015

Are you health illiterate?

Are you health illiterate?
CBC Radio: 7.27.2015 by Dr. Brian Goldman

Modern medicine is complicated, which is what smart doctors are for, right? Well, maybe not. More and more experts think the key to better outcomes is a smarter patient - one who is informed about personal health. An article published last week says doctors should dumb down their instructions to patients. I think that idea is even dumber.

The article - by doctors at Thomas Jefferson University in Philadelphia - says that doctors should assume that in general, patients do not understand medical advice.  In other words, until proven otherwise, doctors should assume that patients are illiterate in health information.  Therefore, they should avoid using medical jargon when explaining diagnosis or treatment to the patient - unless the jargon is essential, in which case it should be explained clearly.  The authors also say that in general, when doctors talk to patients, they should speak or provide written handouts aimed at the grade five or six level.  When speaking, the authors say doctors - should - speak - slowly - and break down information into small manageable steps.  There's a lot more, but you get the drift.

The authors say studies show that more than a third of adults living in the U.S. have limited health literacy, making it more difficult for them to read, understand and apply health information.  That includes information presented on medication bottles, hospital discharge instructions, consent forms patients sign prior to surgery, medical forms, and health education handouts.  Studies show that more than 75% of patient educational materials are written at a high school or college reading level - far above the average American patient.  I have no reason to think Canadian patients fare any better at reading comprehension.  Patients don't understand a lot of the words doctors use. They also don't understand the way we use numbers.

It's disturbing to realize that doctors and patients overestimate how much patients are capable of absorbing.  Turns out there are real tools out there that assess health literacy. REALM-R is a word recognition test in which patients are asked to de-code or pronounce medical words like anemia, jaundice and colitis. It screens for poor literacy skills.  The Short Test of Functional Health Literacy in Adults assesses reading comprehension and numeracy skills over two prose passages and four items assessing numerical ability.  There's also a longer version of this test with three prose passages followed by a 50-item reading comprehension section.  The Single Item Literacy Screener has just one question:  How often do you need to have someone help you when you read instructions, pamphlets or other written material from your health professional or pharmacy.

Poor health literacy contributes to lower health standards and health disparities between informed and uninformed patients.  Poor health literacy has been cited as a factor in patients not following doctor's instructions, not taking medication properly and often not taking it at all. Studies show health illiteracy leads to longer stays in hospital and rising rates of poorly managed chronic diseases like type 2 diabetes and high blood pressure.  It leads to lower success rates curing cancer.  Not surprisingly, it also leads to bad health outcomes and in some cases to higher mortality rates.  READ MORE !

Title of Screening Tool
     Rapid Estimate of Adult Literacy in Medicine (REALM)
     Rapid Estimate of Adult Literacy in Medicine - Revised (REALM-R)
     Test of Functional Health Literacy in Adults (TOFHLA)
     Short Test of Functional Health Literacy in Adults (S-TOFHLA)
     Newest Vital Sign (NVS)
     Brief Estimate of Health Knowledge and Action – HIV Version
     Single Item Literacy Screen
     How confident are you filling out medical forms by yourself?
     SOS Mnemonic
Description and Average administration time
Measurement of literacy levels
Strengths and Limitations
Location / Availability: Free, Purchase, or Citation

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