The term “health literacy” has been around for at least 15 years but headway in understanding it and implementing tools to address it is relatively recent. Low health literacy occurs in those who are extremely well-educated as well as those who have low literacy.
If you are entering the US healthcare system with low health literacy, you will have trouble. But your troubles increase exponentially when you also have low literacy. That’s why Peter Morrison collaborates with people with low literacy to create health literacy interventions.
Since 2009, Morrison has been Director of Health Literacy Programming at the Literacy Coalition of Central Texas. There he works with English Language Learners and those with low literacy, as well as national leaders to develop a suite of health literacy services with proven efficacy throughout the state of Texas.
Asked to explain how a person with low literacy experiences the healthcare system, Morrison gives his audience a reading test.
“First, kcehc the egral and rewol rotaidar sesoh along with the rellams retemaid sesoh, hcihw run morf the engine eht llawerif. Inspect hcae esoh along its eritne length, and ecalper any esoh that is dekcarc, nellows, or swohs signs of noitaroireted. If you ezeeuqs the esoh, skcarc may emoceb erom apparent. Make sure the esoh snoitcennoc are tight.”
“Anyone want to take a stab at what this passage is about?” he asks.
Very few of his audience respond. And he is not surprised. “Most of you probably couldn’t answer the question. Some of you probably got frustrated. Some of you didn’t really even try to read it. This is how it feels to be low literate. Even if you broke the code (words spelled backwards) you likely couldn’t answer questions about it.”
He describes the experience further, “When we’re concentrating on individual words, we can’t comprehend sentences and paragraphs. Imagine an informed consent document, “I hereby authorize…blah blah blah.” You’ve lost the low lit person already. They’re stuck on the words “hereby” and “authorize,” so when they complete the sentence, they haven’t gained comprehension.”
Patients with low health literacy often try to disguise or hide their struggles by saying things like “I forgot my glasses, I will read it later.” These are red flags or cues for health care providers, Morrison notes. “One of the biggest barriers faced by low Health Literacy patients is shame of not understanding. This inhibits question asking and promotes head nodding.”
Texas’ large Hispanic/Latino population shapes his work. “Culture plays a big role with English Language Learning patients, but often feelings of shame for not understanding are the same.” He does advise healthcare providers to “be careful assuming translation is enough. People don’t understand “medicalese “in English and patients don’t understand it in other languages either.”
Morrison’s leadership in the field of health literacy is evident in several instances, including a collaboration request by Joint Commission on a nation-wide hospital assessment project. Research validation is part of the success of health literacy interventions he has developed. He does pre- and post- evaluations of workshops, measuring increased knowledge and intent to change behavior. “For instance, a mobile dental van wants their consent form redone. They send forms home to parents of school kids. We’ll look at return rate of consent forms and completion rate of those returned forms.”
Indeed, his expertise has been recognized and rewarded by being selected as one of ten nation-wide American Medical Association consultants for the Communication Climate Assessment Toolkit (CCAT). His enthusiasm for the Toolkit is obvious, “The C-CAT rules! It was developed by the American Medical Association and endorsed by the National Quality Forum. It measures 9 discreet domains of effective communication. This instrument puts hard metrics behind the soft issue of communication. It helps agencies target Quality Improvement Interventions.”
As a strategy for health care providers, Morrison says that Teach-back is the most evidence-based practice in Health Literacy today. But he warns that providers need to insist that patient’s not just repeat back but actually describe in their own words what they are to do, “how they will take medicines for example.”
According to Morrison, the biggest challenge that the US faces to become a health literate society is that society as a whole is not learning what he calls “medicalese.”
“We need a health system overhaul. Providers and the entire system need to transform care to empower the individual. And someone can’t be empowered when they don’t understand the content at hand. The average American reads at 8th grade level. Average health information is written at 10th grade or higher. That’s an example of a system change that’s needed.”
Morrison is feeling positive that the movement to improve health literacy is gaining momentum. “I think we’re on the right track…policy is changing, people are starting to pay attention. “Three years ago I would go into a room and five percent knew about Health Literacy. Now fifty percent do! People are getting it.”
See the full transcript of the twitter chat with Peter Morrison at Health communication, Health literacy and Social Sciences Tweetchat.