In September of 2020, Forbes shared a statistic from the U.S. Department of Education that says 54% of adults ages 16-74 in the United States read below the equivalent of a sixth-grade level. This means that about 130 million people in the U.S. lacked proficiency in literacy as of last year.
This statistic is evidence of a large and often-overlooked barrier to health care in the United States. Literacy level can affect how patients access healthcare services and how they interact with health professionals. In “A Skill-Based Approach for Health Literacy Education in Chiropractors,” available on Learn ACA, Dr. Valerie Ubbes, PhD, MCHES (pictured), explains the concept of health literacy, addresses some of the challenges that low literacy can pose in health care, and suggests how doctors of chiropractic can be more attuned to literacy in their own practices.
What is Health Literacy?
In her webinar, Dr. Ubbes breaks down several types of health literacy. Personal health literacy describes an individual’s ability to find, understand, and use information to inform health-related decisions. Organizational health literacy has to do with an organization’s ability to enable individuals’ personal health literacy. As Dr. Ubbes explains, doctors of chiropractic have the opportunity to improve their clinics’ organizational health literacy as well as their patients’ personal health literacy.
“We know people with low literacy go to the hospital more often as opposed to using preventive care,” Dr. Ubbes explains. “For chiropractic, that’s important to know because there’s a lot of preventive care that’s making chiropractic a bridge to allopathic and osteopathic medicine. People ought to be looking at chiropractic care as health.”
Improving Patient Encounters
Health literacy encompasses verbal, written and body language, Dr. Ubbes explains, so chiropractors looking to improve their patients’ health literacy should look at all three categories. “As I argued in my presentation, chiropractic should be foregrounding the body language and the oral language, but a lot of times the written language is not there,” Dr. Ubbes says.
Written communication begins before the doctor even enters the room. Intake can pose problems for patients with lower literacy if forms are not easy to understand. “You want to make sure that all the forms they fill out are large print, plain language, and the choice of words is not multisyllabic,” Dr. Ubbes explains. Plain language is another concept that Dr. Ubbes emphasizes in her presentation. Keeping language simple and free from jargon helps ensure better understanding for all patients. “It doesn’t mean that these patients are ignorant or incapable. It’s just a matter of using the universal precautions, which means that everybody would be given the same information at a 5th-6th grade level. People can always read down a level, but they can’t always read up a level.”
In appointments with patients, Dr. Ubbes encourages doctors to keep a notepad next to them and write down a few main points as they explain things to their patients. “It’s a prompt for improving cognitive recall or memory,” she explains. “There’s a lot of cognitive load in the interactions between a doctor and a patient, no matter how intelligent and how educated the patient is.”
Writing down cues can help with recall, as can the teach-back method. Dr. Ubbes suggests that doctors ask patients to repeat instructions back after they are given. “The onus is on the doctor to make sure that what they said is understood, not on the brilliance of the patient,” she says. “If the patient can repeat back 1-2-3, that’s even better because then that means the doctor gave it out in a procedural 1-2-3 approach.”
Numbers are an important element of plain language communication. “Organize the information that’s really important up front, and you want to break the information that’s a little bit complex into parts,” she suggests. “If it’s procedural, if there’s some kind of process order to it, always use 1-2-3. People are used to having numbers as a hook and it helps cue them. And go ahead and point to your first, second, third finger. Get as manual as you can to give people multiple hooks.”
For doctors to be able to explain things effectively to patients of varying literacy levels, Dr. Ubbes says that doctors must be able to use these plain language tactics. “It’s not putting a hierarchy in there of the doctor and the patient. We as human beings just need a plain language interaction.”
Types of Health Literacy
A doctor interpreting information to share with a patient is an example of interactive health literacy, another type of health literacy that Dr. Ubbes discusses in her webinar. She explains it along with functional health literacy, which is the ability to read write, and speak about health. “Can the patient read and write when they take that initial front-office visit and fill out forms? Can they speak about their own health and disclose to the doctor what hurts, what feels good, and be able to use body parts and naming when they do that?” These are a few of the questions chiropractic physicians can ask themselves when it comes to their patients’ health literacy. Another question relates to critical health literacy, the most complex type.
“That’s more of an empowerment model. The physician should be thinking, ‘How can I empower the people in my community?’” Dr. Ubbes says. “Can you be critical about your practice and really look at ‘Are those people who may need chiropractic care getting it, and if not, why is that?’ A lot of times it’s due to literacy.”
To learn more about the types of health literacy and how you can implement some of these tactics in your chiropractic practice, watch “A Skill-Based Approach for Health Literacy Education in Chiropractors” on Learn ACA.
Cassie LaJeunesse is an associate in ACA’s branding and communications department.