North Carolina AHEC Program
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Improving Health Communication: The Development of Health Literacy Materials

Nedra Edwards Hines, MHABy Nedra Edwards Hines, MHA, allied health coordinator, Northwest AHEC

Health outcomes are directly impacted by a person’s ability to understand health issues and treatment recommendations and instructions. Therefore, it is very critical that health professionals start to incorporate health literacy into practice. In order to begin this integration, they will need to first educate themselves and their staffs, and subsequently they can also affect the health literacy of their patients, ultimately improving health outcomes. AHECs can play an important role by educating health clinicians in this vital area by offering health literacy continuing education, as well as providing similar health literacy materials discussed in this article as examples.

In the fall of 2007, the Northwest Area Health Education Center (Northwest AHEC) received a three-year grant from the Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services, and the Carolina Geriatric Education Center. The grant focused on coordinating regional community-based interdisciplinary geriatrics education and health literacy.

Continuing education is an integral component of the AHEC mission while health literacy was an area that had not been fully explored. To increase our staff’s knowledge about health literacy, several staff participated in the Center for Aging & Health/Carolina Geriatric Education Center training on Faculty Development in Health Literacy and Aging and other staff attended a health literacy workshop held at one of the other eight regional AHECs in North Carolina. The goals of these trainings were to:

As a result of participating in these trainings and ideas from staff meetings, three guides to aid health professionals and patients with health literacy were developed.

Health Notes BookletThe Health Notes Booklet is a 38-page portable record of health information for patients. Patients or family members/friends are able to write down important health information such as emergency numbers, contact information for primary physician, health history, lab tests and past surgeries and procedures, list of prescriptions, supplements and home remedies, and information about advance directives. In addition, throughout the booklet are health tips and information about avoiding infection and preventing errors in the hospital, controlling diabetes and heart disease, managing medications, and the description of a living will, health care power of attorney, and MOST (Medical Orders for Scope of Treatment) forms.

Many seniors have inadequate or marginal literacy skills and are unable to understand basic health information. This booklet was developed to ease communication between seniors and physicians. Many seniors may not be able to write in the book themselves but with the help of family and friends, their information can be listed in this portable record. Although the booklet was developed for seniors, people of all ages have taken advantage of this resource.

There were a few challenges in developing the Health Notes Booklet. The idea was to have a guide that was small enough to fit in a pocket or purse as anything bigger would be cumbersome to carry. But the challenge was to make the guide and its print big enough to allow seniors to easily write in and read. In addition, keeping the amount of pages to a minimum was a challenge. Health history for some could contain a lot of information. The goal was to have seniors list the most important information that their physician, nurse or pharmacist would need to know.

Good Questions cardIn addition to the Health Notes Booklet, a two-sided laminated card was developed for patients. Good Questions for Good Health When Visiting the Doctor, Nurse or Pharmacist, A Patient’s Guide for Better Health card focuses on the Partnership for Clear Health Communication ASK Me 3 campaign. The 3 Questions to Ask Your Doctor, Nurse or Pharmacist are:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

The card stresses that the three questions need to be asked when visiting the doctor, nurse or pharmacist, when preparing for medical tests or procedures and picking up medicine.

The back side of the card gives tips to manage one’s health such as: bringing a family member or friend to a doctor visit; asking your doctor to explain a word, idea or direction if you don’t understand; and ask questions about cost and insurance coverage. The information listed on the card is short and written in language that is understandable.

Health Literacy BrochureThe third document was created for health professionals in mind. Health Literacy and Your Patient is a front and back laminated guide that calls attention to the major problems and effects of low health literacy and what professionals can do to help patients understand basic health information. Helpful tips on this card encourage professionals to use plain and simple language, define technical terms, ask open-ended questions, and check for understanding by asking the patient to restate the information in his or her own words.

A letter and copies of the materials were sent to organizations in the Northwest AHEC region in the summer of 2008 and 2009. Organizations were appreciative and eager to receive the information. The majority of the guides that have been distributed since summer of 2008 resulted from referrals and word-of-mouth. All of the materials provide information on how to order additional copies. Health professionals and/or organizations can request copies which are mailed free of charge, as the grant also covers postal expenses. In addition, Northwest AHEC staff have been encouraged to distribute the Health Literacy & Your Patient guide to all health professionals they encounter (i.e., place in continuing education handout packets, meetings, etc.).

Based on feedback from health professionals, seniors, and caregivers, Northwest AHEC-created guides that are an asset to those who do not always remember their health information. The following are quotes from groups who have received the guides:

“These will be wonderful for our patients preparing for discharge!” Alston Brook Nursing & Rehabilitation Center

“We are really excited about receiving this information and passing it on to our patients! This is really a fantastic idea!” Stokes Family Health Center

“Thank you! I love the empowerment tool for patients. Great idea!” Gateway Rehab & Health

“I think this is great! This will help our families and residents.” Big Elm Nursing and Retirement

“Our patients love the booklets!” Catawba Valley Internal Medicine

More than 25,000 Health Notes Booklets, Health Literacy & Your Patient guide and A Patient’s Guide for Better Health card have been distributed at no cost to patients, continuing education participants, hospitals, long-term care facilities, public health departments, physician offices, Office of Regional Primary Care Education preceptors, local AARP groups, a local health insurance company, community agencies and groups, developmental centers, and AHEC libraries.

Throughout this process, there have been several requests to translate the Health Notes Booklet into Spanish. The original plan did not include development and production of Spanish versions. As guides were disbursed, several organizations requested Spanish versions. Additionally, North Carolina has a sizeable Latino population and this request makes sense. Therefore, as part of the Year 3 goals of the grant, Northwest AHEC will identify an appropriate organization that specializes in Spanish translation, and proceed to have the materials translated and produced. Plans also call for the guides to be distributed to community care clinics as well as making them available via the Northwest AHEC Web site. Posting the materials online will allow users to view the documents and place orders.

About the Author: Nedra Edwards Hines is the coordinator of Continuing Education for Allied Health at Northwest AHEC. To enhance the AHEC mission, Edwards Hines works with the Northwest AHEC interdisciplinary team as well as allied health associations, individual practitioners, educational organizations, and other AHEC mission-aligned partners to assure a well-prepared and geographically well-distributed allied health workforce in the Northwest AHEC 17-county region. Prior to working at Northwest AHEC, Edwards Hines has served as an education coordinator, adjunct instructor, health educator, and program manager for a number of community-based healthcare facilities while collaborating with health professionals. Edwards Hines’s formal education includes a Bachelor of Science degree in Public Health Education from the University of North Carolina at Greensboro and a Master of Health Administration degree from Pfeiffer University.