Assessing Patient Health Literacy for Improved Outcomes, Safety

November 19, 2019 - As healthcare increasingly moves from volume to value, it’s becoming imperative for providers to understand more than what patients present at their yearly checkups. 

Environmental factors, such as where a patient lives and works, as well as an individual’s access to nutritious food and other resources, can impact patient health even more than clinical elements.  

Patient health literacy, or a patient’s understanding of her health conditions and possible treatments, is a critical, non-medical aspect of improving patient safety and outcomes. 

In 2018, patient health literacy made ECRI Institute’s Top 10 Patient Safety Concerns for Healthcare Organizations, ranked under diagnostic errors, opioid misuse and safety, and care coordination. 

While most organizations understand the importance of evaluating patient health literacy, many still struggle to assess an individual’s understanding of his or her medical conditions, industry experts noted at Xtelligent Healthcare Media’s Fourth Annual Value-Based Care Summit in Boston. 

“The thing about judging a patient’s health literacy is that it's kind of a challenging assessment,” said Elena Nuciforo, PhD, visiting lecturer of the Department of Health Promotion and Policy at the School of Public Health at the University of Massachusetts Amherst.  

“There’s a whole range of tools out there that doctors and nurses can use to assess health literacy, but a lot of them focus on functional health literacy. These tools ask patients, ‘can you read this label?’ ‘Can you understand these numbers?’”

Instead of these cut-and-dry, yes-or-no questions, providers could ask their patients questions that may provide a glimpse into their situation outside the doctor’s office.

“Asking more open-ended questions can ensure that a person shares the context of where they live, their housing situation, as well as some of the struggles they face in terms of access to resources,” Nuciforo continued. 

“With questions like these, you're able to know whether the person understands their health situation and what kind of resources they have access to, as well as their insurance information or their payment options.” 

Jenni Gudapati, program director for Value-Based Healthcare at Boise State College of Health Sciences, echoed these statements. 

“When you start having those educational discussions with your patient, a lot of times, you can't come up with a goal if you can't assess how much your patients know,” Gudapati said. 

“So a lot of times, I open up the education sessions by asking my patients, ‘What do you know about your health condition? What do you know about this disease?’ And you can take their knowledge to create meaningful goals that they can relate to.”

For providers, it can also be helpful to consider patient health literacy from different points of view. 

“When I'm explaining my medical goals to patients, I’m thinking, ‘Is the patient able to understand that, and do they have the tools and the resources to be able to engage with what I'm saying?’”  said Salina Bakshi, a fellow at the Center for Population Health at Partners Healthcare.

“I try to think about it from both the provider and patient perspectives when I'm talking to patients directly in the office,” Bakshi, who is also the assistant medical director for primary care at Brigham and Women’s, added.

Panelists pointed out that it’s important to remember that often, health literacy education extends past the patient. 

“When patients leave the hospital and they're on their own, a lot of times, they’re thrown so much information. Providers can really ensure health literacy by talking about instructions not just with patients, but also with patients’ caregivers,” said Gudapati. 

Ensuring patients achieve their medical goals once they leave the hospital or other healthcare settings will require health literacy education for entire care teams, including family members, personal caregivers, and community health leaders.

“If you look at the statistical data, you'll see that most of the patients do not spend most of their time with doctors and nurses who have a medical education, are highly specialized, and have certifications and licensing. Instead, they spend a lot of time with personal care attendants, personal care aides, and family caregivers. We sometimes assume that people who are providing that direct care have a certain level of health literacy. Very often, they don't,” Nuciforo said.

“Working with community health workers, I've noticed that they themselves sometimes struggle with a lot of health literacy issues,” she added. 

Working alongside caregivers can help improve patient health literacy and understanding, Bakshi stated. 

“We have community health workers in our office who can go with patients to their appointments. They can go with patients to specialty appointments, and they can do home visits,” she explained. 

“By having providers partner with community health workers, we're able to get a better in-depth sense of patients’ health literacy. We’re able to collaborate with other members of the healthcare team to better help our patients.”

Assessing patient health literacy is a critical part of improving safety and outcomes, but providers can fully understand what their patients know only when they ask the right questions. 

“You might think that your patient has a good understanding of their medications, but if you don't really understand what they do and they don't know, you can’t help them in the best way possible,” Bakshi said.

“Really understanding where your patients are coming from, what their needs are, and what their goals are, is your best opportunity to know what someone's health literacy is.” 

Join us in Austin June 3-5, 2020 for the Value-Based Care Summit & Telehealth20!