Health Literacy Is About More Than Language

Even more seasoned healthcare professionals focus more on the language interpretation and cultural aspects of health literacy rather than seeing the whole picture. Health.gov gives a rather extensive definition of health literacy. In simplest terms, health literacy is a patient's ability to receive information about their health and be able to apply that information to meet their health needs and to improve their health and well being.

Although that sounds simple enough, it often is not. Even though studies have shown that using medical terminology does not assist in patient understanding of medical issues, clinicians continue to use complex medical terminology with patients. 

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That is the crux of the issue. Discussing medical issues with "me" at "my" level of understanding, as a patient, as a person, as an educated person. In order to do so, healthcare professionals first must take the time to determine what "my" level of understanding may or may not be. I have heard different thoughts on health literacy and how to communicate with patients and their families. Some may say explain it to people like they are your grandmother, or your mother, or a five-year-old. First of all, I do not think that most people would really appreciate you talking to them like a five-year-old or your grandmother if they are in their 20s or your mother if they are a male in their 50s. The best course of action, in my opinion, is to have a general understanding of their language, education, socioeconomic, and cultural backgrounds.

Language is more than the actual language we speak. Language includes dialects, vernacular, and levels of understanding. As pointed out in "My Fair Lady", English is not spoken the same by everyone. As Rex Harrison says, "Why in America, they haven't spoken it for years." Even within the same cities in America, citizens speak different levels of English and have different levels of understanding of the words presented to them. Taking a lot of time to explain medical terminology may not be the best use of a clinician's time for me. However, taking time to explain medical issues to a patient with limited medical knowledge may be beneficial for another patient. That is, meet the patient at the level of  language understanding. If the patient speaks using a lot of common phrases, then the clinician could mirror the type of language that they speak.

The type of language spoken may, but does not always, vary with education level. Clinicians should not assume that because someone holds a bachelor's degree that they will have a better understanding of the clinical information presented to them. Nor, should clinicians believe that someone with a high school diploma does not understand medical terminology. Rather, time should be taken to determine the patient's individual level of understanding. This can reduce medical errors and make the patient feel like an integral part of the care team, as they should be.

Another important factor in determining a patient's health literacy is their socioeconomic status. Someone who holds two jobs and works 80 hours a week most likely is not going to have time to go home and research several websites about their illness. Some patients may be more concerned about how much their visit is going to cost and how they are going to pay the bill than the actual diagnosis. They may never even read their discharge summary other than to find out what medication was prescribed or their diagnosis. Patients may even be confused about the actual diagnosis and disease. Thus, discharge summaries and other medical documentation should be reviewed with patients prior to its release. Patients should have a very clear understanding of their diagnosis and health issues. Just as clinicians do an answer back and team meeting, patients also should be able to do an answer back regarding their health status. When a clinician asks a patient to describe the health issue, the patient should be able to verbalize the issue itself, the treatment plan, what the issue and the treatment plan mean, and how the health goals will be accomplished.

In order to accomplish health goals, a patient's cultural background should be considered. The media today focuses a great deal on cultural background meaning the ethnicity or race of an individual. However, culture includes many factors. Someone from a rural community has a different cultural background than someone from an urban community, for example. Even in a rural community, those living "in town" may have a different culture than those living in the "country". Those living in the "country" also may have different subcultures. Some of those who live in the most rural areas may be farmers, while others may not be. Culture can include levels of family closeness, celebrations, eating habits, and even how family members associate with one another.

Whatever the case may be, health literacy is about a patient's ability to understand the information about their health that is presented to them. Health literacy improves patients' health, improves patient-provider relations, and also increases patient safety.

Sources:
Quick Guide to Health Literacy, found online at https://health.gov/communication/literacy/quickguide/factsbasic.htm
Dingley et al. Improving Patient Safety Through Provider Communication Strategy Enhancements, found online at https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Dingley_14.pdf
The Joint Commission. "What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety," found online at https://www.jointcommission.org/assets/1/18/improving_health_literacy.pdf
Centers for Disease Control and Prevention. Health Literacy, found online at https://www.cdc.gov/healthliteracy/
American Institute of Medical Sciences and Education. The Language of Healthcare: Learning Medical Terminology, found online at https://www.aimseducation.edu/blog/the-language-of-healthcare-learning-medical-terminology/
Koch-Weser, Dejong, Rudd. Medical Word Use in Clinical Encounters. Health Expect, found online at https://www.ncbi.nlm.nih.gov/pubmed/19709316