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Improving Health Literacy – Keystone Elder Law – Mechanicsburg, PA

Improving one’s health literacy requires an understanding of the educational obstacles described in last week’s article, as well as concepts about how people make decisions and the practical implications of applying those decisions to daily life.

A panel of professional experts in the field of health literacy met in 2009 to discuss the status of health literacy among older adults. One of the presentations at this conference dealt with communicating health information in terms of gains and losses and how this communication can influence an individual’s decisions about care and treatment.  In general, research has shown that if treatment choices are explained according to the benefits a person might gain, the person is likely to choose the “sure thing” or the most predictable option.  On the other hand, if the discussion focuses on losses that the individual might experience, a riskier treatment option is more likely to be chosen.  When an individual is considering a decision about a specific treatment, it may be beneficial to look at the potential outcomes from both viewpoints.  For example, consider a person with arthritis who is considering pain management with medication versus knee surgery.  If the physician states that with proper dosages, medication will minimize the discomfort so that the individual can continue to go about their daily routine, this sounds like a safe and reasonable choice.  But if instead, the physician states that with only pain medication, the person might eventually need to use a walker, does that change how one considers the potential risks of surgery?

Also related to health care decision-making is the frequent presence of a “trade-off.” An individual may have to choose whether or not to comply with a treatment that will improve one aspect of health but negatively impact another (medication side effects are a prime example). A second common trade-off is improved health versus financial burden.  Will the potential benefits of a suggested treatment outweigh lifestyle adjustments that must be made in order to afford the treatment?  In both of these situations, the cognitive skill of understanding probability and risk plays a role, and this skill is one of the most challenging required for health literacy.  Many people are reluctant to admit that they may not fully understand information that has been presented, and may answer “No” when asked if they have any questions.  Instead of answering “No,” the patient should try to rephrase the information that has been communicated by a care provider, “Do you mean that if _____________, then I will ____________?”  This allows a care provider to assess where there may be gaps in understanding.

Linda Miller, a Community Services Coordinator from North Carolina who was part of the 2009 expert panel, suggested six steps that professionals can take to improve educational interactions with older adults:

  • Keep the information focused
  • Repeat it as needed
  • Allow time for the individual to process the information
  • Communication should take place in person, and the information should be relevant to the individual
  • Draw attention to the short-term benefits of taking a specific action
  • Provide follow-up

Older adults can do their part toward improving interactions with health care providers by taking time to identify and prioritize the issues of concern prior to an appointment. Writing down questions can help organize thoughts and help one get the most out of an appointment. While physicians may not have time to answer every question, they can address the most important ones, and then perhaps nurses or other office staff can spend a few extra minutes covering the remaining concerns. Take time to write down the answers also, as a reference for later on. It is also important to be specific about how a situation is affecting your life.  Telling a care provider that you have a pain in your shoulder might get you a prescription for pain medication.  Telling the provider that the pain makes dressing difficult and that you are staying at home in your pajamas every day should elicit a stronger response.

Older adults must also be honest with their care providers about the practical application of health information to their daily lives. An individual may understand health information and want to follow through with it, but challenges may exist which will complicate the plan.  How much professional support will the individual need, and is this support available in their community?  What distractions are present which will hinder compliance, such as family situations or financial concerns?  Does the individual have limitations (physical, emotional, or barriers in the home setting) which will impact their ability to carry out instructions or perform certain tasks?  Even when health literacy may be limited, individuals can be successful in meeting their health goals when they are assisted to develop “a reliable, sustainable self-care system that is useful in their everyday environment” (Dr. Joanne G. Schwartzberg, American Medical Association, 2009).

Efforts by both individuals and professionals toward improving health literacy can create information that is more useful and relevant, leading to care that is higher quality and more cost effective. The greatest benefit for individuals and society will be better overall health.

Karen Kaslow, RN, BSN