Enhancing Health Literacy With Written Materials
The impact of printed discharge instructions
Health literacy predicts overall health better than any other factor, according to the American Medical Association (AMA).[1]
It makes sense. Patients who understand their health and their treatment plans become engaged partners in their care. They are safer and more likely to use medications correctly. Because they know what to do and why it is important, they participate in preventative care and actively manage existing conditions.
The impact of health literacy has been researched extensively. Poor health literacy leads to poor compliance with treatment plans,[2] higher risks of hospital readmission,[3] and even a higher risk of death after discharge.[4] One study of elderly patients found a 5-year mortality rate of 39.4% in patients with inadequate health literacy versus only 18.9% in those who understood their conditions well.[5]
Barriers to Health Literacy During Hospitalization
If can be difficult for patients to comprehend medical topics and achieve good health literacy at the best of times. Hospitalization — one of the primary times patients are taught by healthcare providers — is also inherently one of the hardest times to learn.
Pain, fear, illness, stress, and many medications interfere with understanding and recall. Some conditions — like head injuries — directly inhibit cognitive functioning. Whether patients are facing a new diagnosis, surgery, or critical illness, there is often a lot of information to cover. The amount of information itself can be overwhelming, creating another barrier.
Further blocks to understanding can include:
Complex information
Low education level
Language differences
Age-related cognitive decline
Even if these obstacles are not present, the teaching method can interfere with comprehension. The best practice is for healthcare providers to space out discharge instructions and teaching over the course of a hospitalization, but this doesn’t always happen. Time and staffing are short. Frequently, teaching gets crammed into a few minutes right before patients leave.
With all these factors, it’s no wonder that research finds a significant portion of patients can’t remember discharge instructions right after they leave the hospital.[6]
The Impact of Written Discharge Instructions
Written materials can help healthcare providers make the most of teaching. Once patients are oriented to printed materials, they can reference them throughout their hospital stay. The right materials become an extension of the healthcare provider’s voice. When the patient is ready to go home, teaching on the day of discharge becomes a review and an opportunity to ask questions.
Giving written materials in addition to using other teaching methods is also a key to understanding. Most people do not comprehend information easily by listening alone. In one study, 98% of patients and their caregivers preferred having written resources rather than verbal instruction only.[7] Long-standing research has shown that written discharge instructions increase compliance with treatment plans,[8] help patients recall information,[9] and reduce the chance of readmission.[10]
Match Patient Needs for Enhanced Comprehension
Effective written materials match the patient's needs. They explain health concepts in a simple way at an appropriate reading level. Tables, checklists, pictures, and accessible design make a big difference too. Research shows that well-designed pictographs help significantly improve discharge instruction recall.[11]
Whenever possible, materials should also be translated into the patient's native language. In the United States, Spanish-language translations are mandatory, with 42 million Americans reporting Spanish as their primary language.[12]
Finding Health Information After Discharge
No matter how diligently healthcare providers work to overcome barriers to understanding, patients will forget some information. Once they forget, they also tend to look for answers in unreliable places. According to the National Cancer Institute’s Health Information Trends Survey, 69% of people go to the internet for health information and only 16% to their doctor.[13]
While most people have heard that the internet contains health misinformation, they may assume that major websites are safe. However, expert reviewers examined 48 websites, including popular, widely referenced sites, and found the accuracy was only around 50%.[14]
Patients are also more and more likely to turn to AI for health answers. A panel of orthopedic surgeons tested ChatGPT’s answers to patient questions about a total joint replacement surgery and found that only 52% of the answers were acceptable.[15]
Giving patients an easily accessible, reliable reference for questions after discharge is critical. Written discharge instructions can provide this reference and help patients avoid poor decisions based on inaccurate information.
Conclusion
The right written materials can promote health literacy, combat misinformation, and inform health decisions so patients can have better outcomes. For the best results, equip patients with materials that are well designed and easy to understand. Patient Guide Solutions’ patient education materials were designed by a team of bedside nurses, physicians, and design professionals to match your patient’s health literacy needs.
References:
[1] Health Literacy: Report of the Council on Scientific Affairs. JAMA. 1999;281(6):552-557. doi:https://doi.org/10.1001/jama.281.6.552
[2] Gold DT, McClung B. Approaches to patient education: emphasizing the long-term value of compliance and persistence. Am J Med. 2006;119(4 Suppl 1):S32-7. doi:10.1016/j.amjmed.2005.12.021
[3] Bailey SC, Fang G, Annis IE, O’Conor R, Paasche-Orlow MK, Wolf MS. Health literacy and 30-day hospital readmission after acute myocardial infarction. BMJ Open. 2015;5(6):e006975. doi:10.1136/bmjopen-2014-006975
[4] McNaughton CD, Cawthon C, Kripalani S, Liu D, Storrow AB, Roumie CL. Health literacy and mortality: a cohort study of patients hospitalized for acute heart failure. J Am Heart Assoc. 2015;4(5). doi:10.1161/JAHA.115.001799
[5] Baker DW. Health literacy and mortality among elderly persons. Arch Intern Med. 2007;167(14):1503. doi:10.1001/archinte.167.14.1503
[6] Sanderson BK, Thompson J, Brown TM, Tucker MJ, Bittner V. Assessing patient recall of discharge instructions for acute myocardial infarction. J Healthc Qual. 2009;31(6):25-33; quiz 34. doi:10.1111/j.1945-1474.2009.00052.x
[7] Fric M, Thull-Freedman J. Patient caregiver preferences on discharge instructions from the Alberta Children’s Hospital Emergency Department. Canadian journal of emergency nursing. 2022;45(2):12-13. doi:https://doi.org/10.29173/cjen184
[8] Sammons JH. Written Instructions and Patient Compliance. JAMA. 1982;248(21):2890-2890. doi:https://doi.org/10.1001/jama.1982.03330210072042
[9] Hoek AE, Bouwhuis MG, Haagsma JA, et al. Effect of written and video discharge instructions on parental recall of information about analgesics in children: a pre/post-implementation study. European journal of emergency medicine. 2020;28(1):43-49. doi:https://doi.org/10.1097/mej.0000000000000746
[10] VanSuch M, Naessens JM, Stroebel RJ, Huddleston JM, Williams AR. Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care? Quality & safety in health care. 2006;15(6):414-417. doi:https://doi.org/10.1136/qshc.2005.017640
[11] Zeng-Treitler Q, Kim H, Hunter M. Improving patient comprehension and recall of discharge instructions by supplementing free texts with pictographs. AMIA Annual Symposium proceedings AMIA Symposium. 2008;2008:849-853. Accessed May 10, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656019/
[12] US Census Bureau. Nearly 68 Million People Spoke a Language Other Than English at Home in 2019. Published online 2022. Accessed November 3, 2023. https://www.census.gov/library/stories/2022/12/languages-we-speak-in-united-states.html
[13] The most recent time you looked for information about health or medical topics, where did you go first? | HINTS. Cancer.gov. Published 2014. Accessed May 10, 2024. https://hints.cancer.gov/view-questions/question-detail.aspx?PK_Cycle=11&qid=688
[14] Zade RT, Tartaglione JP, Chisena E, Adams CT, DiCaprio MR. The Quality of Online Orthopaedic Oncology Information. Journal of the American Academy of Orthopaedic Surgeons Global research & reviews. 2020;4(3):e19.00181-e19.00181. doi:https://doi.org/10.5435/jaaosglobal-d-19-00181
[15] Wright BM, Bodnar MS, Moore AD, et al. Is ChatGPT a trusted source of information for total hip and knee arthroplasty patients? Bone & joint open. 2024;5(2):139-146. doi:https://doi.org/10.1302/2633-1462.52.bjo-2023-0113.r1
More Topics
