Nursing Interventions for Health Literacy

Health Literacy Interventions Albert Einstein once stated "If you can't explain it simply, then you don't understand it well enough." This quote sets a high bar for medical professionals in terms of knowledge, but this sentiment an essential requirement for communicating effectively with patients having low health literacy.

For example, if a patient previously diagnosed and treated for HIV / AIDS has subsequently presented with a below normal BMI, hypotension, specific oxygen in the low 90% range, high HIV viral load, very low CD4 count, and is afebrile, there is a good chance that the patient has not been adhering to treatment recommendations. When I encountered a patient with these signs in my clinic I discovered she had failed to understand the correct use of the inhalers she had been prescribed and had exchanged HIV medications for illicit drugs.

The patient also admitted that she could not read; however, it was clear the patient was intelligent and readily grasped several of the medical concepts initially communicated. It was clear that literacy was a significant health barrier for this patient, but not intelligence. Among the many possible communication barriers patients can suffer from, the above patient had only a few. These included language barriers, language of nursing, medical and scientific jargon, and inadequate prior communications.

The communication process depends on the following elements: (1) message, (2) sender, (3) receiver, (4) encoder, (5) channel, (6) decoding, and (7) feedback loop. Based on the information provided by the above patient, the communication process failed during the initial diagnosis and treatment because the message was not adequate to the task. This may have been due to the failure of the sender (physician) to recognize there was a health literacy issue confronting the receiver (patient) or the clinic had insufficient time and resources to provide an effective health literacy intervention.

Due to the lack of sufficient message, the encoding, decoding, and feedback elements could not be evaluated. Since the patient had dropped out of school before learning to read, this presented a significant communication barrier and rendered written treatment instructions useless. In addition, given the lack of academic achievement it would be difficult to convey complicated medical concepts to the patient in a meaningful way.

Given these limitations, an appropriate individual health literacy intervention would be one that emphasized the importance of message, encoding, decoding, and feedback; thereby helping the patient adhere to treatment recommendations. The message could be broken up into smaller chunks of information and encoded using simple words, concepts, and pictures.

To verify that the message and encoding elements were working as intended the patient could be asked to repeat the information to the clinician, demonstrate a good grasp of the concepts by 'teaching' the clinician the same material, and engage in a discussion of the options, risks, and benefits of a given treatment recommendation. Improving the communication techniques of the sender would also be important. For example, sitting forward, making and sustaining eye contact, use of non-verbal communication cues,.