Pt Reading levels r/t health literacy Kristen D’Alberto, Marijo DiMora, Kim Sayles

The World Health Organization has defined health literacy as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health”

Why do we need to be aware of patient reading levels? Functional health illiteracy results in poor patient outcomes, non-compliance with treatment plans, limited self-management skills, and increased health complications.

The Frightening Truth The most recent national literacy survey reported that 43% of the population have basic to below basic literacy skills. Approximately 14% of adults could not understand a basic patient education pamphlet and 36% could not perform moderate to difficult tasks such as reading a childhood vaccine chart, or determining possible medication interactions from a prescription label. Approximately 50% of Medicare/Medicaid recipients read below the fifth grade reading level.

Evidence-based practice

Are nursing students provided with the appropriate education about patient health literacy concepts and the ability to apply them in clinical settings? Purpose To determine the impact of a brief health literacy education session on nursing student knowledge of health literacy concepts and the ability to apply this knowledge to their patients. Setting A brief education session about health literacy for 112 sophomore nursing students at a large Mid-Atlantic University BSN program. A pre- test was given to all students before a 20 minute presentation of low-health literacy concepts. A post-test was given after containing the same questions as the pre-test. Results The results indicated a significant increase in student knowledge about health literacy after the brief educational session. The mean scores increased from 6.5 to 8.4 on the 10-item inventory. Conclusion This study shows the significant increase in nursing student knowledge scores after presentation in the classroom setting indicating that even short education intervention can impact student knowledge of critical health literacy issues. The evidence shows that graduate nurses need to be able to identify patients at risk for not being able to understand and act on health information, communicate health information and instructions in a way that promotes understanding, and assess patient understanding.

People with low health literacies claim to be good readers when, in fact, they cannot read. Easy-to-use Assessment Tools Single-Item Literacy Screener (SILS) Rapid Estimation of Adult Literacy in Medicine (REALM) Short Test of Functional Health Literacy in Adults (S-TOFHLA)

Single-Item Literacy Screener (SILS) A tool using one question to identify adults who need help with reading. “How often do you need to have someone help you when you read instructions, pamphlets or other written material from your doctor or pharmacy?” In one study using SILS, patient responses were very useful in predicting difficulty with reading printed health material. SILS is a very quick tool and practical for use during a routine clinical encounter.

Score of 1 indicates there is no help needed Score of 2 indicates there is rarely help needed Score of 3 indicates there is sometimes help needed Score of 4 indicates there is often help needed Score of 5 indicates there is always help needed Scores >2 are considered positive, indicating some difficulty with reading printed health related material.

Rapid Estimation of Adult Literacy in Medicine (REALM) A tool that uses pronunciation of health care terms to determine approximate reading level arranged and ordered by difficulty, starting with one-syllable words and ending with multi-syllable words. Subjects read as many words as they can. Standard dictionary pronunciation is the scoring standard. The number of words read correctly is recorded and this sum is translated to one of four grade-level literacy categories. The 66-item REALM takes 2-3 minutes to administer and score.

Scores 0-44 indicate reading skills at or below the 6th grade level Scores from 45-60 indicate skills at the 7th or 8th grade level Scores >60 indicate skills at the high-school level or higher. Patients with scores ≤ 60 are considered at risk for misunderstanding written information provided to them.

Short Test of Functional Health Literacy in Adults (S-TOFHLA) A tool using 2 reading comprehension passages with missing words where they fill in the blanks: 1st passage is at the fourth grade reading level 2nd passage is at the tenth grade reading level The 2-passage S-TOFHLA takes approximately 8 minutes to administer and score.

Scores 0-53 indicates Inadequate Health Literacy Scores 54-66 indicates Marginal Health Literacy Scores 67-100 indicates Adequate Health Literacy

A more simple approach Ask your patient to perform simple reading skills: Have your patient read back to you a medication label/medication pamphlet. Have your patient correctly describe in his or her own words the written information in a handout.

Once you have established your patient’s reading level …

Use teach-back method to assess patient understanding. Explain information in short, simple terms avoiding potentially confusing medical terminology. Use alternative teaching forms such as videotapes, audiotapes, television, pictures, diagrams, graphs, charts, etc. Assure that family members are present during teaching whenever possible. Present information in small increments due to the short attention span of most patients.

2014 National Patient Safety Goals NPSG.03.06.01 Record and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Make sure the patient knows which medicines to take when they are at home. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor. This NPSG is an example of how important it is to assess and consider patient’s reading level before discharge teaching occurs.

Let’s review

Question #1 50% of Medicare/Medicaid recipients read below which grade level? A. Eighth grade B. Eleventh grade C. Fifth grade

Question #2 What is an easy-to-use tool to assess patient’s reading level? A. Glasgow Coma Scale B. Single Item Literacy Screener (SILS) C. Rapid Estimation of Adult Literacy in Medicine (REALM) D. Short Test of Functional Health Literacy in Adults (S-TOFHLA) E. Answers B, C, & D

Question #3 What is a more simple approach when assessing patient’s reading level? Select all that apply. A. Look in patient’s chart for highest level of education achieved B. Have patient read back a medication label to nurse C. Have patient read a discharge handout and describe in own words what was read D. Ask patient how well they are able to read

How would you explain this discharge medication order to your patient? Acetaminophen 325 mg po q4h prn pain MDD 4 g *Remember to always use layman’s terms!