Abstract
Every individual must acquire health literacy, which determines their understanding of health situations and terminology. Health literacy levels can be measured through various tools, such as the National Assessment of Adult Literacy (NAAL) and Rapid Estimate of Adult Literacy in Medicine (REALM). Health literacy affects health both directly and indirectly, as patients are involved in practices that may compromise their quality of health due to a lack of necessary medical information.
High literacy in health matters results in better healthcare, lower hospitalization rates, and improved self-care and health outcomes. When dealing with a family with a low literacy level, interventions entail clear communication, confirmation of understanding, proper administration and medication instructions, and improving practices for geriatric patients. Meeting with other providers is essential when dealing with patients with a low level of health literacy to facilitate collaboration and improve their outcomes.
Introduction
Health literacy is a term used to describe a person’s ability to understand and meet the complex demands concerning health in the modern world (Nutbeam et al., 2018). Literacy represents the social and cognitive skills that determine a person’s ability and motivation to gain access to, understand, and use information to promote and maintain good health (Nutbeam et al., 2018). Literacy in health matters is considered a fundamental goal of public health and may have a significant impact on the health outcomes of patients. Individuals with poor health literacy may experience significant consequences, including a decline in their overall health status.
Health literacy is a practical, fundamental, and economical measure to enhance health (Nutbeam et al., 2018). Understanding concepts related to health literacy may promote and improve health outcomes. Nurses are essential in teaching patients vital healthcare topics, such as medication administration and discharge instructions. This is a significant part of the nurses’ job to empower their patients and improve the quality of their health.
The Institute of Medicine (IOM) designated health literacy as a concept that must be included in “prelicensure nursing education” (Mosley & Taylor, 2017). Health literacy is crucial in educating clients about diagnostic tests, health, and informed decision-making regarding treatment (Nutbeam et al., 2018). The focus of this paper is to discuss health literacy in the context of caring for families and individuals as a family nurse practitioner.
Measuring Health Literacy
The level of comprehension and integration of basic health information to make better and healthier decisions can be measured in several ways. The critical components of the assessment are communication, comprehension, navigation, function, health information seeking, need for assistance, decision-making, and critical thinking (Liu et al., 2018). The growing interest in health literacy has necessitated the development of measurement tools.
The tools that support health literacy measurement differ in their design, approach, and purpose (Liu et al., 2018). The National Assessment of Adult Literacy (NAAL), which provides systematic feedback on the healthcare and education systems regarding the literacy levels of adults, was selected (Liu et al., 2018). NAAL identifies disparities in age, ethnicity, gender, race, and insurance status.
Rapid Estimate of Adult Literacy in Medicine (REALM), Tests of Functional Health Literacy in Adults (TOFHLA), and the Newest Vital Sign (NVS) (Parker, 2009) analyze the relationship between low health literacy and health outcomes. These tools are often used in clinical settings and are quick, short, and easy to use (Parker, 2009). These tests, within the broader concept of literacy, aim to provide an in-depth assessment of the dimensions of literacy.
Furthermore, different instruments can be effective in measuring specific illness literacy. Diabetes Numeracy Test (DNT-15) helps measure literacy concerning diabetes. The Asthma Numeracy Questionnaire (ANQ) and Literacy Measures of Patients with HIV would help measure literacy for asthma and HIV concurrently (Liu et al., 2018).
How Health Literacy Affects Health
Directly
Health literacy affects nearly every facet of health, from medical knowledge to mortality. Health literacy is associated with patients engaging in complex illness management and self-care (Huang et al., 2021). Low health literacy is often associated with patients who have limited education, are older, have chronic conditions, are low-income, and are non-native English speakers (Huang et al., 2021).
Patients who cannot interpret information on their health have increased hospitalization rates, develop more illnesses, and experience high mortality. For example, Patients with low HL have 50% more chances of being hospitalized than those with adequate HL (Suhail et al., 2021). It is estimated that many individuals enter Long Term Care (LTC) at a younger age due to poor health literacy.
Mothers with low literacy skills may not prepare formulas correctly and improperly feed their infants (Huang et al., 2021). Low health literacy is associated with a person’s inability to follow safety precautions, especially when they are ill. Individuals may struggle to read written instructions for preservative care, follow-up care, and self-care after an illness or injury (Huang et al., 2021). They may experience challenges understanding appointment leaves, discharge information, informed consent forms, and oral instructions. A patient with low literacy is likely to use fewer preventive health services, such as vaccines, mammography, and Pap smears.
Indirectly
Health literacy can indirectly impact a person’s health status by affecting their health behaviors. Individuals with lower health literacy have a high chance of living in low-quality housing and unsafe places. These areas have high environmental hazards and pollution (Suhail et al., 2021). These individuals are less likely to have safety features such as smoke detectors. Patients with low health literacy skills are unlikely to request care early in their illness (Hughes, 2008). Most of the time, they continue living with health conditions, and the situation may have escalated by the time they get medical attention. Persons with low health literacy skills may engage in negative behavior such as smoking more, lack exercise, and poor nutrition (Suhail et al., 2021). This situation may result in illnesses and poor health for the individual.
How Health Literacy Influences Response to Illness and Health
Health literacy is closely tied to value-based healthcare, which emphasizes improving patient outcomes. Persons with higher health literacy tend to have better health and lower hospitalization rates. These patients experience fewer trips to the emergency room, higher medication adherence, and higher protective care.
Patients can comprehend information about their health, are more likely to understand their diagnosis, and comply with care plan instructions (Gaffari-Fam et al., 2020). Following these instructions leads to better patient care and improved outcomes. Literacy contributes to more timely follow-up appointments and medication during illness, and the patient can recuperate by improving self-care for people in LTC. Literacy not only improves outcomes for the patient but also helps them save money related to the consequences of poor decision-making in health matters (Gaffari-Fam et al., 2020).
Patients can navigate their healthcare system and health history with healthcare providers, manage their personal health, and engage in self-care, which are significant aspects of treatment. Literacy enables the person to manage chronic illnesses and understand the probability and risk of infection. Instructions on prescription drugs, nutrition labels, and other relevant information would enable patients to take medication appropriately and minimize the chances of medical errors. (Gaffari-Fam et al., 2020). Lower hospitalization and emergency services rates are associated with better health for individuals.
The patient’s health depends on their ability to engage in constructive activities, such as regular exercise, a healthy diet, and drug abstinence. Patients in long-term care have benefited from exercise and nutrition, resulting in improved balance and overall body strength. High levels of health literacy are correlated with good search behaviors. (Gaffari-Fam et al., 2020).
Interventions with a Family Based on Level of Health Literacy
An issue of limited health literacy is highly prevalent in the United States. As stated, Patients with limited health literacy are more likely to have poor health status, hospitalization, and mortality rates (Nutbeam et al., 2018). While working with families who have low literacy, one may notice that they tend to use a more passive communication style, which can harm interactions with doctors. They lack engagement in shared decision-making and report that interactions with their physicians are not empowering or helpful (Nutbeam et al., 2018). Approaches when engaging with such a family require implementing a range of system-wide strategies (Nutbeam et al., 2018) that may be more effective in overcoming these challenges.
In my experience dealing with dementia patients in an LTC home, sometimes, families with poor health literacy make poor judgments that obstruct team decision-making and postpone the optimal outcome for their loved one. They often decline to take part in any educational activities. That can be a significant ethical issue, enabling the sector to implement policies that help promote health literacy among members who refuse to attend educational programs.
Clear Health Communication
Overwhelming patients with information, using technical language and terminology, and failing to assess patients’ understanding are all common communication issues (Paudel et al., 2022). Excellent communication is often the most effective strategy for addressing health inequities. Dealing with a family with limited health literacy relies solely on verbal instructions.
Verbal communication must be clear when addressing them (Paudel et al., 2022). Plain language can be used while communicating with the patient and family. The best way is to avoid jargon and use short dialogue while explaining medical-related information (Nutbeam et al., 2018). To avoid confusion, the clinician should use the exact words as the patient, put the patient’s needs first, and discuss no more than three key points (Paudel et al., 2022). In long-term care, clear health communication has helped solicit critical health information needed for effective patient care and complete healing.
Confirmation of Understanding
Confirmation of understanding is one of the most significant aspects of good communication in healthcare. Simply asking questions such as ‘do you understand?’ or ‘do you have any questions?’ may not be very effective in inquiring if the patient understands the information (Nutbeam et al., 2018). A phrase such as ‘What questions do you have?” is an open-ended question that empowers them to give answers to the inquiry. Once they ask the questions, be involved in properly explaining the solution in simple terms.
The following steps would be to assess their understanding using the ‘teach back,’ ‘teach to goal,’ or the ‘show me’ method to confirm their understanding (Nutbeam et al., 2018). These methods are techniques in which a Nurse Practitioner can ask the patients to restate or demonstrate the technique or knowledge they just learned. These methods definitely initiate the interactions between the patient and encourage them to use positive feedback (Nutbeam et al., 2018).
Additional reinforcement modalities, like drawing graphs and pictures, will enhance communication. Multimodal teaching aids have promising effects in cases where written and verbal information is ineffective (Paudel et al., 2022). Using pictures to present the data helps with increased interest, understanding, and comprehension. Videos may be effective, as patients can watch them at their own pace to standardize the contents and successfully communicate complex ideas (Paudel et al., 2022).
Medication
Dosing regimens should be included in the patient’s and family’s daily routine, emphasizing the utilization of fewer pills and substituting them with alternative options. Coordination of dosage for a similar time during the day may help them recall medication periods. Once prescribed, it is essential to confirm regimen dosage consistency to increase compliance (Paudel et al., 2022). Medication organizers or official medication schedules may allow pictures of pills to be placed on weekly calendars. To help with medication reconciliation, dedicated review and evaluation visits could be set up (Paudel et al., 2022).
Geriatrics
Special considerations should be implemented when dealing with geriatric patients for clear communication. Basic considerations include accommodating visual, hearing, and cognitive impairments. With high rates of visual impairment among this age group, it is recommended to use at least 14 points and non-serif fonts for written materials and use bright contrast colors in writing to prevent glare (Nutbeam et al., 2018).
According to the World Health Organization (n.d.), about 25% of older adults are affected by hearing impairment. When communicating with deaf patients, it is vital to face the patient as they may depend on lip reading and decrease background noise. An assistive hearing device can be helpful in such cases. For patients with cognitive impairment, clear health communication and reinforcement strategies may help provide medical information or use caregivers to present the details (Nutbeam et al., 2018).
Communicating with Other Healthcare Providers and Institutions
During the treatment, the patient may interact with various healthcare providers, including nurses, physicians, lab technicians, and others. Efficient and accurate communication is key to providing high-quality patient care. Collaboration with care providers ensures that professionals assume complementary roles, cooperatively work together, and share responsibility in problem-solving and decision-making to carry out a plan for patient care (Nantsupawat et al., 2020). Those with low health literacy could benefit from better collaboration between the organization and healthcare providers. For patients with low health literacy to comprehend the information, all parties involved must provide it in a way that is accessible to them(Nantsupawat et al., 2020).
After establishing strategies to assist patients with poor literacy as a nurse practitioner, one ensures that the knowledge is communicated accurately and precisely to other practitioners. The nurse would use written communication to address the needs of the family members with limited health literacy. Additionally, it is advisable to encourage the staff to promote continuity and clarity with the patient care team.
Collaboration between healthcare professionals will continually increase team member awareness of the demands needed to improve the patient’s situation. A team’s efficiency is directly proportional to its level of communication (Schoultz, 2017). The nurse must record patients’ information in medical records on transfer and referral forms. They should also provide patient care information using care plans and medical history reports.
Conclusion
The improvement of health literacy can effectively enhance the health status of individuals. Through advocacy, education, and communication, an APN can play a significant role in fostering health literacy among their patients. Carrying out actions that promote national health literacy to improve health literacy among clients is still the primary task of the public health framework (Nutbeam et al., 2018).
A person’s health literacy is measured by how well they can locate, understand, and apply relevant health information to make educated health decisions and act based on what they learn (Gaffari-Fam et al., 2020). Low health literacy has both a direct and an indirect impact on one’s current state of health. There is a correlation between its presence and increased hospitalization rates, illness development, and mortality.
Confronting the difficulties associated with health literacy calls for implementing intervention techniques and effective communication with medical professionals (Gaffari-Fam et al., 2020). Due to the prevalence of people with inadequate health literacy, assessing their level of understanding of their health needs to be considered in all areas of clinical practice (Heinrich,2012). The importance of self-care is a key relationship between health literacy and health-related quality of life. Promoting continuity will involve concise sharing of patient medical information amongst providers and building trust between patients and other healthcare teams (M. O’Daniel,.2008). Effective communication and education are crucial components of the health care system to improve the outcomes and experiences of care for individuals with low health literacy.
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