In the Journals

Recognizing patients’ health literacy improves outcomes

Michael Cooper
Michael Cooper, Jr.

Pediatric providers and medical assistants estimated health literacy among English- and Spanish-speaking caregivers poorly, according to findings published in Health Literacy Research and Practice.

“Health literacy is so critical to patients’ well-being,” Michael Cooper Jr., MD, of the department of pediatrics at the University of Oklahoma Health Sciences Center, told Healio Family Medicine. “Think about it — in every medical encounter, parents are an integral partner. For example, if we prescribe a child medication or a treatment that lasts for a week or two, the mother or father will have to administer that treatment at home and watch for particular signs at which time they need to come back and we change course.”

“[Previous] studies did not examine staff estimation of caregiver health literacy or literacy estimation of Spanish-speaking caregivers,” Cooper and colleagues wrote.

Thus, researchers evaluated 50 caregivers using Newest Vital Sign, which focuses on numeracy and comprehension. A different set of 50 caregivers were assessed using the Short Assessment of Health Literacy — a tool that measures different skills in caregivers based on their reading skills. All the physicians and nurse practitioners were native English speakers and all medical assistants were native bilingual English/Spanish speakers. Interpretation services were utilized as needed.

Cooper and colleagues found no overall association between dichotomized physician/nurse practitioner or medical assistant estimation and caregiver score for either tool. However, providers’ estimates were less likely to match caregiver scores when the caregiver’s language was Spanish (Newest Vital Sign RR = 0.57; 95% CI, 0.37-0.87; Short Assessment of Health Literacy RR = 0.37; 95% CI, 0.23-0.6).

“We were surprised that the primary language concordance was so important. We thought that providers appropriately using an interpreter or competently using their second language to communicate to caregivers could mitigate some of the difference in our inability to figure out who was understanding our instructions among those speaking a primary language concordant or discordant from the provider. It really didn’t, and so we should be more vigilant when we are practicing cross-language medicine,” Cooper said in the interview.

He noted that the findings, if taken on a broader scale, could suggest why some patients are noncompliant and suggested clinicians carefully educate patients on their health needs — whether it be checking their BP, taking medicine, or the myriad of other conditions that brings a patient in for an office visit, rather than take a one-size-fits-all approach.

“There isn’t one strategy that is going to work for every patient, but try to design your teaching so that people, even if they are not understanding as well or for some reason have some barrier to literacy, that even for them your instructions would be understandable. Always check for understanding,” Cooper said.

“One possibility is to institute the ‘universal health literacy precautions’ because you have to consider the possibility that all individuals will have limited comprehension, even when it’s not obvious, and then check to ensure the patient understands,” he said.

The universal health literacy precautions include not using medical jargon, breaking down information or instructions into small specific steps, limiting the focus of a visit to three critical points or tasks, then assessing for patient understanding. The precautions also include providing printed information that is written at or below a fifth- to sixth-grade reading level and utilizing visual aids such as graphs or pictures, according to previously published research. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

Michael Cooper
Michael Cooper, Jr.

Pediatric providers and medical assistants estimated health literacy among English- and Spanish-speaking caregivers poorly, according to findings published in Health Literacy Research and Practice.

“Health literacy is so critical to patients’ well-being,” Michael Cooper Jr., MD, of the department of pediatrics at the University of Oklahoma Health Sciences Center, told Healio Family Medicine. “Think about it — in every medical encounter, parents are an integral partner. For example, if we prescribe a child medication or a treatment that lasts for a week or two, the mother or father will have to administer that treatment at home and watch for particular signs at which time they need to come back and we change course.”

“[Previous] studies did not examine staff estimation of caregiver health literacy or literacy estimation of Spanish-speaking caregivers,” Cooper and colleagues wrote.

Thus, researchers evaluated 50 caregivers using Newest Vital Sign, which focuses on numeracy and comprehension. A different set of 50 caregivers were assessed using the Short Assessment of Health Literacy — a tool that measures different skills in caregivers based on their reading skills. All the physicians and nurse practitioners were native English speakers and all medical assistants were native bilingual English/Spanish speakers. Interpretation services were utilized as needed.

Cooper and colleagues found no overall association between dichotomized physician/nurse practitioner or medical assistant estimation and caregiver score for either tool. However, providers’ estimates were less likely to match caregiver scores when the caregiver’s language was Spanish (Newest Vital Sign RR = 0.57; 95% CI, 0.37-0.87; Short Assessment of Health Literacy RR = 0.37; 95% CI, 0.23-0.6).

“We were surprised that the primary language concordance was so important. We thought that providers appropriately using an interpreter or competently using their second language to communicate to caregivers could mitigate some of the difference in our inability to figure out who was understanding our instructions among those speaking a primary language concordant or discordant from the provider. It really didn’t, and so we should be more vigilant when we are practicing cross-language medicine,” Cooper said in the interview.

He noted that the findings, if taken on a broader scale, could suggest why some patients are noncompliant and suggested clinicians carefully educate patients on their health needs — whether it be checking their BP, taking medicine, or the myriad of other conditions that brings a patient in for an office visit, rather than take a one-size-fits-all approach.

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“There isn’t one strategy that is going to work for every patient, but try to design your teaching so that people, even if they are not understanding as well or for some reason have some barrier to literacy, that even for them your instructions would be understandable. Always check for understanding,” Cooper said.

“One possibility is to institute the ‘universal health literacy precautions’ because you have to consider the possibility that all individuals will have limited comprehension, even when it’s not obvious, and then check to ensure the patient understands,” he said.

The universal health literacy precautions include not using medical jargon, breaking down information or instructions into small specific steps, limiting the focus of a visit to three critical points or tasks, then assessing for patient understanding. The precautions also include providing printed information that is written at or below a fifth- to sixth-grade reading level and utilizing visual aids such as graphs or pictures, according to previously published research. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.