Dr. Shalini Forbis developed an interest in health literacy when she was dealing with a lot of asthmatic patients whose parents didn’t fully understand how to dispense their children’s medications.
“We looked at the literacy levels of the parents and they were low,” said Dr. Forbis, a pediatrician at Dayton Children’s. “We wanted to find out how that impacted how well parents care for their children.”
She began studying what providers can do to overcome this kind of barrier. This track led her to two recent studies on health literacy that she will be presenting at this year’s Boston University Medical Campus Health Literacy Research Conference on Oct. 17 and 18 at Northwestern University in Chicago.
In private practices, about 10 percent to 20 percent of parents have literacy challenges. Providers in underserved areas see this rate jump to around 40 percent, Forbis estimates. And she said illiteracy typically impacts health literacy – the ability to understand things like medication instructions, health consent forms and medical education brochures.
This issue has come to the fore more prominently in recent years, and has been studied in specific populations, including patients with asthma and diabetes. Dr. Forbis’ research, however, took a broad stroke approach, looking at four general pediatric practices in the Dayton area.
The first study used audio recordings of physicians, nurses and staff to track their use of “positive” health literacy practices like plain language and review of materials versus the “negative” techniques like overuse of medical jargon. They found that providers did use plain language and explanations of medical terminology, but also were unaware of how frequently they used poor techniques.
When surveyed after the recordings were done, 89 percent said they typically use everyday language instead of medical terminology. But use of medical terminology and concept terms were the negative communication techniques most often found on the audiotapes. And 48 percent of physicians and staff said they assessed patients for understanding, but there were only 0.01 occurrences found per 10 minutes of tape.
“Physicians should be aware of using value terms, like asking if their child is breathing too fast,” Dr. Forbis said. “Parents are likely not certain what that might be when we know it is breathing faster than 60 times a minute.”
The second study provided training at three of the four Dayton practices. The training was based upon the American Medical Association’s Health Literacy Education modules. It covered health literacy, creating a shame-free environment, verbal and written communication, and integration of the learned information into the clinical environment.
The researchers followed up a year later to assess the effectiveness of the training on providers and staff. At the sites that had received training, the providers and staff were more aware of the issue of literacy limitations.
But they also found few changes made at these same sites. The staff did not provide easier-to-read handouts, even though the researchers gave them to the offices. Nor was the staff more likely to help with forms, reinforce key information or demonstrate how to administer medication. There were also no differences in the number of well child visits.
“We have learned that increasing awareness we can do easily, but changing behaviors for people out in practice is different,” Dr. Forbis said. “People are going to have to study how we can affect behavior change to improve health literacy practices. We likely need to provide more intensive training at early stages like during residency because behaviors seem more set later on.”
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