Literacy in Adult Population Dr. Belal M. Hijji, RN, PhD April 17, 2012

2 Learning Outcomes Define some of concepts relevant to literacy Discuss clues indicating patient illiteracy Describe the impact of illiteracy on compliance and motivation Examine strategies that an educator should follow in teaching low-literacy patients

3 Definition of Terms Literacy: Is an umbrella term used to describe socially required and expected reading and writing abilities. Health literacy: Refers to how well an individual can read, interpret, and comprehend health information for maintaining an optimal level of wellness. Low literacy: Refers to the ability of adults to read, write, and comprehend information between the fifth and eighth-grade level of difficulty. Functional literacy: Refers to the ability to read, write, and comprehend information below the fifth-grade level.

4 Assessment of Patient Literacy Identifying illiteracy is not easy because it has no particular face, age, socioeconomic status, or nationality. Nurses are in ideal position to determine the literacy level of their patients. Because illiteracy is prevalent, nurses should never assume that their patients are literate. Nurses need to know a patient’s ability to read and comprehend as this is critical in providing teaching-learning encounters that are useful and effective. There are a number of informal clues to look for that indicate reading and writing deficiencies. These are:

5 –Reacting to complex learning situations by withdrawal or complete avoidance. –Using the excuse that they were too busy or too tired. –Claiming that they did not feel like reading or that they lost their glasses. –Camouflaging their problem by surrounding themselves by load of books or magazines. –Circumventing [يتغلب بالمراوغة] their inability by insisting on taking the information home to read or having a family member with them when written information is presented. –Asking someone to read as they “are not interested”. –Listening and watching very attentively to observe and memorize how things work. –Failing to ask any questions about the information they received.

6 Impact of Illiteracy on Motivation and Compliance Poor literacy skills affect the ability to read, understand and interpret the meaning of written, visual, and verbal instructions Poor reading skills result in difficulty in analysing instructions, assimilating and correlating new information, and formulating questions. For example, a patient who ingested a suppository orally because she was not able to read the word! Illiterate clients have difficulty synthesising information in a way that fits into their behaviour pattern. If they can’t comprehend a required behaviour change or can’t understand why it is needed, then any health teaching will be disregarded. For example, a cardiac patient who received verbal and written information to lose weight, increase exercise, decrease fat intake, and take medication may fail to comply with this regimen because of lack of understanding of the information and how to incorporate these changes into lifestyle.

7 A limitation in people with poor literacy skills is that they think in only concrete, specific, and literal terms. An example is a patient whose glucose levels were out of control even when he insisted that he was taking insulin as instructed – injecting the orange and then eating the fruit! Poor literacy skills is responsible for the failure of patients to handle a large amount of information and classifying it into categories. Patients ordered several medications to be taken at various times and in different dosages may become confused with the schedule or noncompliant. Poor literacy skills tend to limit the patient’s ability to understand the array of instructions regarding medication labels, dosage scheduling, and side effects.

8 Teaching Strategies for Low-Literate Patients Teaching patients with poor reading skills needs to be viewed as a challenge rather than a problem. Teaching methods and tools need to meet the logic, language, and experience of the patient who has difficulty in reading or understanding. The following strategies are suggested to for nurse educators to use: –Establish a trusting relationship before beginning the teaching- learning process. –Use the smallest amount of information possible to accomplish the predetermined behavioural objectives. Stick to the essentials, paring down what the information you teach to what the must learn. –Make points of information as vivid [clear, very bright] and explicit as possible. Explain information in simple terms, using everyday language. For example, a sign reading “NOTHING BY MOUTH’, or “NPO” should be changed to “Do Not Eat or Drink Anything”.

9 –Teach one step at a time. Teaching in increments and organising information into chunks [pieces] help to reduce anxiety and confusion and give enough time to patients to understand each item before proceeding to the next unit of information. –Use teaching methods and tools requiring fewer literacy skills. Oral instruction contains cues such as tone, gestures, and expressions that are not found in written materials. However, a spoken word lacks punctuation and capital letters. Therefore, a patient with poor reading skills may have difficulty with understanding the spoken language and with reading. –Allow patients the chance to restate information in their own words and to demonstrate any procedures being taught.

10 –Keep motivation high. An illiterate patient may feel like failure when he is unable to work through a problem. Reassure him that that it is normal to have trouble with new information and that he is doing well, and encourage him to keep trying. –Build in coordination of procedures. Simplify information by using the principles of tailoring and cuing to facilitate learning. Tailoring means to coordinate or incorporate a patient’s regimen into his daily schedule rather than forcing him to adjust lifestyle to a regimen imposed on him. For example, incorporating a medication schedule to a patient’s mealtime does not drastically alter his lifestyle and increase motivation. Cuing focuses on the appropriate combination of time and situation using reminders to get a person to do routine tasks. For example, placing medications where they best can be seen on a frequent basis or keeping a simple chart to check off each time a drug is taken. –Use repetition to reinforce information.