Helping patients improve their health literacy: Effective strategies for nurses and nurse managers

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A nurse, holding a chart, talks to a child and her mother in an exam roomAccording to the U.S. Centers for Disease Control and Prevention (CDC), when individuals understand basic concepts of health and well-being, such as illnesses, bodily functions, regimens of treatment and care, and so on, they are described as having proficient health literacy skills. Nurses and nurse managers, as well as physicians and other medical professionals, play an important role in ensuring that patients understand varying health-related issues and concerns, particularly those related to their health and well-being. This knowledge, in turn, improves patients’ health literacy.

However, a report from the Office of Disease Prevention and Health Promotion revealed that health literacy skills among the U.S. population remain limited. The National Assessment of Adult Literacy reported that just 12 percent of Americans possess competent health literacy skills, making the need for greater health literacy among the general population apparent.

A closer look at the importance of health literacy

As detailed by researchers Nichole Egbert and Kevin M. Nanna in an article published in The Online Journal of Issues in Nursing, there is no single definition of health literacy that has received widespread agreement among researchers. Rather, a number of similar, yet slightly different, understandings of the term have been proffered by organizations such as the American Medical Association and World Health Organization.

The definitions extended by these groups, however, essentially carry the same message — that individuals are said to have proficient health literacy when they are able to process and understand basic information and instructions related to personal health care, helping them stay as healthy as possible. Egbert and Nanna offered several official definitions, including that of the World Health Organization: Health literacy is “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.”

Proficient health literacy is important because, as outlined by the CDC, poor health literacy skills increase an individual’s risk of the following:

  • Not receiving treatment or receiving treatment too late.
  • Taking medication incorrectly or making other dangerous mistakes.
  • Experiencing treatment outcomes that are poorer than those with more advanced health literacy.
  • Needing treatment and other services to a greater extent than those with good health literacy.

Why are health literacy levels low?

Individuals struggle to develop proficient health literacy for a number of reasons. As detailed in the Office of Disease Prevention and Health Promotion report, certain demographics are at a higher risk of inadequate health literacy. Examples of these groups include individuals with low income or who live in rural or underserved areas, racial minorities, older adults and those who did not complete high school. Egbert and Nanna explained that perhaps the most significant barrier to proficient health literacy is access to information. Due to factors such as age, lack of access to transportation, an inability to connect with online resources, language, cultural differences, and education level, individuals with poor health literacy often are unable to access the comprehensive education they need to improve their health literacy skills.

Even when people with poor health literacy skills are able to access health information, either online or in person from a health care provider, barriers such as mistrust and poor reading and writing skills can increase the risk of miscommunication.

Strategies for nursing professionals

Given the value of proficient health literacy, it is important that healthcare professionals, including nurses and nurse managers, lead efforts to ensure patients are as informed as possible, both in terms of preventative health care measures — understanding why it is important not to smoke cigarettes, for example — and actions needed to treat any current health care problems, such as adhering to a medication regimen.

Nurses, nurse managers, and general health care providers can use the following strategies for improving health literacy among patient populations:

1. Creating a welcoming environment

Egbert and Nanna explained that a common barrier to proficient health literacy for patients is a lack of trust in providers. Patients may feel uncomfortable communicating about health-related issues with nursing professionals or physicians for any number of reasons, including language and cultural differences or even just a general dislike of their providers. For example, if health care professionals come off as rude, direct, or dismissive, the trust may be eroded.

According to Sandy Cornett, Ph.D., writing in The Online Journal of Issues in Nursing, an effective first strategy for addressing health literacy disparities is to establish a welcoming environment for all patients that is more conducive to the development of trust. Such an environment can be engendered if all health care professionals work on positive communication skills, such as greeting all new patients with a smile and maintaining eye contact during conversation. If patients feel welcomed and that they are being listened to, they will be more likely to ask questions and divulge more helpful information. It also is helpful for all health care professionals to ask patients whether they feel as though they need more information or have any questions.

2. Making use of printed information

In an article for the British Columbia Medical Journal, Dr. Romayne Gallagher suggests using printed materials, such as diagrams and pamphlets, as an effective way to relay crucial information to patients. Gallagher stressed that the most accessible materials will use elementary language, which is comprehensible at the middle-school level. He noted that it is helpful to test the materials on patients for a limited period of time to determine their efficacy.

3. Using basic language

Understanding the nuances of health-related issues can be a challenge, even for more educated patients. Such difficulties often are exacerbated when health care providers use medical terms that patients likely will not understand. The solution, as explained by Frank Federico, for the Institute for Healthcare Improvement, is for health care professionals to use the simplest possible language when explaining a health problem or delivering instructions. Using basic language is an effective strategy for avoiding miscommunication that should be applied on a case-by-case basis, as using overly simplistic language to certain patients may cause offense.

4. Speaking at a measured pace

Gallagher stated that it is common for health care providers to relay information quickly, often due to the fact that scheduling is tight and appointment times are limited. This delivery style is a mistake, however, as patients likely will miss important details if information is given too quickly. Health care providers should speak at a slow and measured pace, emphasizing important points when necessary.

5. Asking questions

An effective tool that health care providers can implement to determine whether a patient understands what is being explained is by asking simple questions, Federico explained. The accuracy of the patient’s answers will demonstrate whether the important information and/or instructions were understood.

6. Encouraging questions

Health care providers also should encourage patients to ask questions and articulate concerns, no matter how tight the provider’s schedule is, Gallagher noted. Egbert and Nanna stated that trust between patients and providers only can be cultivated if patients feel as though their questions and concerns are being listened to and taken seriously. Patient questions also enable providers to discern more effectively whether the patient has any gaps in knowledge or understanding that could be problematic.

Consider Bradley University

Nurse managers work on the frontlines of helping patients to improve their health literacy skills. If you are eager to develop your career in the field of nursing by becoming a nurse manager, consider applying to Bradley University’s online Master of Science in Nursing program.


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