Welcome to my presentation on Health Literacy in the Community By Sharon Herring

Health literacy is the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment. American Medical Association

According to the National Assessment of Adult literacy 9 out of 10 adults have difficulty using everyday health information. Research from the National Science Foundation confirms that adults have little knowledge of basic scientific and biological processes making it even more difficult to communicate routine health information. Paasche-Orlow, M. K., & Wolf, M. S. (2010). Promoting Health Literacy Research to Reduce Health Disparities. Journal Of Health Communication, doi: / National Assessment of Adult Learning. National Center for Education Statistics.

In addition culture, linguistics, cognitive processes, life stage, prior knowledge and message characteristic are also an issue in health literacy. Public health interventions need to be patient centered and communicated from the perspective of the lives of the target population. Paasche-Orlow, M. K., & Wolf, M. S. (2010). Promoting Health Literacy Research to Reduce Health Disparities. Journal Of Health Communication, doi: / National Assessment of Adult Learning. National Center for Education Statistics.

In society the level of health literacy affects the ability to Access and navigate the health care system Manage chronic diseases Use preventative services Understand and adhere to medical advise and instructions Be involved in health Benjamin, R. (2010). Health Literacy Improvement as a National Priority. Journal Of Health Communication, doi: /

According to an article in Journal of Health Communications “health professionals contribute to the unneeded complexity of the healthcare system with poor communication and limited dedication to patient education. Clinicians use jargon and rarely confirm if patients understand what is being discussed” (Paasche-Orlow, M.K., 2010). Paasche-Orlow, M. K., & Wolf, M. S. (2010). Promoting Health Literacy Research to Reduce Health Disparities. Journal Of Health Communication, doi: /

In an effort to develop a patient education tool the Stonhecypher Model was developed. This was based on low literacy levels, behavior theories and role modeling. Theoretically it states “Successful patient education programs are directly related to the ability of health care professionals to apply theories of health behavior. Effective patient education is developed when theories are combined to support learning” (Stonecypher, K. (2009).

Health Belief Model Adult Learning Theory Social Cognitive Theory Self Efficacy Theory Stonecypher Model Stonecypher, K. (2009). Creating a patient education tool. Journal Of Continuing Education In Nursing, 40(10), doi: /

The integration of several theories establishes the foundation of the Stoneocypher Model for patient education. The Health Belief Model was the central theory, with three theories – Adult Learning Theory Self-Efficacy Theory and Social Cognitive Theory, lending support. Stonecypher, K. (2009). Creating a patient education tool. Journal Of Continuing Education In Nursing, 40(10), doi: /

The Social Cognitive Theory provides understanding and insight that support or guide changes in behavior. Behaviors are determined not solely by knowledge, but rather by the outcome and efficacy expectations related to performing them Knowles’ Adult Learning Theory maintains that problem solving with active participation, applying past success to current situations and immediate use of new knowledge by knowledge retention. Clayman, M. L., Pandit, A. U., Bergeron, A. R., Cameron, K. A., Ross, E., & Wolf, M. S. (2010). Ask, Understand, Remember: A Brief Measure of Patient Communication Self-Efficacy Within Clinical Encounters. Journal Of Health Communication, doi: / Stonecypher, K. (2009). Creating a patient education tool. Journal Of Continuing Education In Nursing, 40(10), doi: /

The Social Cognitive Theory provides understanding and insight that support or guide changes in behavior. Behaviors are determined not solely by knowledge, but rather by the outcome and efficacy expectations related to performing them Knowles’ Adult Learning Theory maintains that problem solving with active participation, applying past success to current situations and immediate use of new knowledge by knowledge retention. Clayman, M. L., Pandit, A. U., Bergeron, A. R., Cameron, K. A., Ross, E., & Wolf, M. S. (2010). Ask, Understand, Remember: A Brief Measure of Patient Communication Self-Efficacy Within Clinical Encounters. Journal Of Health Communication, doi: / Stonecypher, K. (2009). Creating a patient education tool. Journal Of Continuing Education In Nursing, 40(10), doi: /

Here are two interventions that could be used by nurses in various settings. These incorporate patient perspectives, the culturally diverse and lower literate populations. Ask, Understand,Remember TEACH Back Help Patients Understand [from AMA Health Literacy Tool Kit]. (2008, June 3). In Cultural Competence Online for Medical Practice (CCOMP). Retrieved October 30, 2013 UnityPoint Health. (2013, October 3). Always Use Teach Back!. In Institute for Healthcare Improvement. Retrieved October 30, 2013

AURA – Ask Understand Remember Assessment. The AURA is a brief and simple measure of a patient’s perceived self-efficacy to obtain, understand, and remember health information from his or her physician. AURA is also useful in identifying and assisting patients who are at risk for errors or non-adherence with self-care behaviors. Clayman, M. L., Pandit, A. U., Bergeron, A. R., Cameron, K. A., Ross, E., & Wolf, M. S. (2010). Ask, Understand, Remember: A Brief Measure of Patient Communication Self-Efficacy Within Clinical Encounters. Journal Of Health Communication, doi: /

The AURA assessment tool with just 4 easy questions.

Teach Back Always Use Teach Back! Teach back is the method, “Tell me, Show me, Ask me” tool that is used to accomplish teach back. This is used to confirm patient understanding of care instructions by asking patients to repeat the instructions using their own words. UnityPoint Health. (2013, October 3). Always Use Teach Back!. In Institute for Healthcare Improvement. Retrieved October 01, 2013

10 Elements of Competence for Using Teach Back Effectively 1.Use a caring tone of voice and attitude 2.Display comfortable body language and make eye contact 3.Use plain language 4.Ask the patient to explain back, using their own words 5.Use non shaming, open-ended questions. UnityPoint Health. (2013, October 3). Always Use Teach Back!. In Institute for Healthcare Improvement. Retrieved October 01, 2013

6.Avoid asking questions that can be answered with a simple yes or no 7.Emphasize that the responsibility to explain clearly is on you, the provider 8.If the patient is not able to teach back correctly, explain again and re-check. 9.Use reader-friendly print materials to support learning. 10.Document use of and patient response to teach-back Unity Point Health. (2013, October 3). Always Use Teach Back!. In Institute for Healthcare Improvement. Retrieved October 01, 2013

ANA Standards of Professional Practice The Teach Back and AURA tools for educating patients align with the Scope and Standards of Professional Nursing practice in that they: 1) Utilize evidence-based practice and research. ANA Professional Nursing Practice Standard 9. 2) Ensures that nurses communicate effective in a variety of formats in all areas of practice. ANA Professional Nursing Practice Standard 11. 3) Allows nurses to demonstrate Leadership in professional practice through communicating effectively with the healthcare consumer. ANA Professional Nursing Practice Standard 12.

These patient education tools to improve health literacy follow the Quality and Safety Education in Nursing (QSEN) Competencies. These competencies call for Patient Centered Care Quality Improvement Evidenced Based Practice Competencies. (2013). In QSEN Institute. Retrieved Octoberr 1, 2013 from

When healthcare professionalsl use these effective evidence-based education tools we can help eliminate health illiteracy and improve patient outcomes.

References: Benjamin, R. (2010). Health Literacy Improvement as a National Priority. Journal Of Health Communication, doi: / Clayman, M. L., Pandit, A. U., Bergeron, A. R., Cameron, K. A., Ross, E., & Wolf, M. S. (2010). Ask, Understand, Remember: A Brief Measure of Patient Communication Self-Efficacy Within Clinical Encounters. Journal Of Health Communication, doi: / Competencies. (2013). In QSEN Institute. Retrieved Octoberr 1, 2013 from Health Literacy. (2013). In American Medical Association. Retrieved October 30, 2013 Help Patients Understand [from AMA Health Literacy Tool Kit]. (2008, June 3). In Cultural Competence Online for Medical Practice (CCOMP). Retrieved October 20, 2013 National Assessment of Adult Learning. National Center for Education Statistics.

Paasche-Orlow, M. K., & Wolf, M. S. (2010). Promoting Health Literacy Research to Reduce Health Disparities. Journal Of Health Communication, doi: / Stonecypher, K. (2009). Creating a patient education tool. Journal Of Continuing Education In Nursing, 40(10), doi: / UnityPoint Health. (2013, October 3). Always Use Teach Back!. In Institute for Healthcare Improvement. Retrieved October 01, 2013