Such a (deceptively) simple concept: let’s confuse patients less

As previously reported at Croakey, Professor Michael Wolf, Director of the Health Literacy and Learning Program at Northwestern University in Chicago, was a keynote speaker at an International Health Literacy Network conference held recently at the University of Sydney.

Marge Overs, who is filing a series of articles from the conference, reports below that Professor Wolf identified some “low-hanging fruit” for health literacy improvements, and also suggested that a Universal Medication Schedule could greatly help patients to better manage their medications.

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Moving beyond the “kitchen sink” approach to health literacy interventions

Marge Overs writes:

The basic goal of health literacy is to “confuse patients less”, Professor Michael Wolf said in this keynote address to The University of Sydney’s health literacy conference last week in Sydney.

There has been an exponential growth in research in health literacy over the past five years, but few interventions have been properly evaluated, Professor Wolf told the conference.

“We need to understand what’s working,” said Professor Wolf, Professor, Medicine and Learning Sciences at the Feinberg School of Medicine, Northwestern University in Chicago.

“Those that have worked we called kitchen sink approaches because we’ve had so many components embedded in them, we couldn’t unpack what was the true cause of improvement.”

Recognised as one of the leading international researchers in health literacy, Professor Wolf opened the conference with a wide-ranging presentation on the growing field of health literacy, which he said means patients being as involved and informed as they want to be in their own health care.

Professor Wolf said health literacy as a field of research initially focused on the effect of literacy and numeracy on people’s ability to engage with the health care system. While it was important not to forget that evidence base, because people with poor reading and numeracy have poorer health outcomes, the field had evolved to far more than that.

“Health literacy encapsulates what it means to be a patient, what it means to be a carer,” he told the conference.  “It means the cultural factors, the experience of being in health care, and your language and beliefs, because you bring all that to the table when you become a patient.”

Limited health literacy affected an individual’s ability to seek information, to understand the disease and treatments, to share in decision making and to adhere to medication instructions.

He said we need to understand the root causes of poor health literacy to design effective solutions, but one of the biggest challenges was engaging the health care system.

“From health literacy perspective we want patients and family members to participate in decision making to a degree that they feel comfortable but does our health care system want the same thing?” he said.

“The goal, regardless of whether we think of this as an individual trait or as an attribute of the health care system is that we have to confuse patients less – we need to figure out what we can offer the patients and how we serve them.”

Professor Wolf said there was an abundance of “low hanging fruit” in improving the health literacy research agenda, with easier tasks including empowering patients to ask questions and be involved, and improving written and multimedia health information.

The more difficult imperatives were modifying delivery of health care, setting policies and standards, and educating young people in health literacy from an early age.

“We need to set policies and standards: what is the health literacy equivalent of fluoridating water or putting seat belts in cars? We need to find a way to make sure that what we have a standard and not have a variable practice,” he said.

“Health literacy is a potentially modifiable factor that we should all be happy to be on board with because there is no audience where you can’t make a strong business case and say this is why health literacy matters – whether you’re talking to a physician, a health care administrator, a drug manufacturer, a pharmacy – this is a wonderful sell, everybody should appreciate it.”

Health professionals have to be engaged in health literacy, and if necessary, accreditation or incentives could be linked to health literacy measures.

“The reality is studies keep showing that whenever we change printed communications, people who struggle to read will still have problems but if you add verbal counselling to the mix they do better,” he said. “So how can you tell me that it takes too much time to do a teach back?”

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Prescription for good communication

Simplifying medication instructions can make a practical and measurable impact on medication adherence, which is challenging at best for many patients, Professor Wolf said.

“There are multiple regimens, variable doses, doses dependent on measurement, daily versus non-daily medicines, limited duration medications, as-needed medications, multiple prescribers, multiple pharmacies, brand versus generic drugs, unsychronised fill dates,” he said.

“This is what it’s like at the ground level for the patient. Where can we find ways to simplify that task of taking medication?”

Professor Wolf is an advocate of the universal medicine schedule (see image), in which standardised instructions separate necessary doses into four periods each day – morning, noon, evening and bedtime.

He says the schedule is much easier to understand than, for example, asking patients to take their medications every eight hours, and has been shown to improve adherence.

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Some tweet-reports…. 

(Click on images to see larger version)

• You can track Croakey’s coverage of the conference here.