Communicating Clearly With Low Literacy Patients: A Skills Workshop

Julie McKinney, MS

Julie McKinney, MS

McKinney and Neuhauser moderated a panel discussion with adult literacy tutors and learners from Read Orange County, a local library program. The panel — tutors Barbara, Al and Fritzi, and learners Van and Jay, and Jay’s mother — shared their expertise for communicating health messages respectfully, clearly and effectively.

The co-hosts indicated that the best way to communicate is by interacting as a shared team – on equal footing, as partners who determine goals, barriers and what works well. Tutors have information about their learners before they meet, including an assessment of what the learners can and can’t do and what they want to accomplish. Tutors and learners then meet at a library or another public place for about an hour twice a week.

The tutors first establish short-term goals (perhaps reading a book) and long-term goals (e.g., getting a driver’s license). They establish a rapport and require learners to show comprehension (not yes or no). They explained that it’s important to use open-ended questions and to convey you’re there as a friend to help them. The tutors get to know their learners’ interests and family dynamics so they can relate to them, break down roadblocks and build confidence.  Each learner has strengths in other areas – not just challenges with reading and writing.

The co-hosts listed several sources for finding local literacy programs:

  • America’s Literacy Directory –
  • Proliteracy –
  • Ask your local library

At the end of the panel discussion, Jay, one of the learners, sang several bars of Louis Armstrong’s song – What a Wonderful World!

Health Insurance Literacy: Solutions from a Successful Model

From left to right: Ryan Barker, MSW, MPPA, Kelly Ferrara, Catina O’Leary, Ph.D.

From left to right: Ryan Barker, MSW, MPPA, Kelly Ferrara, Catina O’Leary, Ph.D.

Catina O’Leary, Kelly Ferrara, and Ryan Barker discussed the strengths and difficulties of the Cover Missouri Coalition and how they collaboratively reached a total of 152,335 enrollments.

The Coalition was established due to the recognition that state was not in full support of Affordable Care Act and as such the state and some county health departments could not participate in outreach and education for the Federal Marketplace.

Although the main goal of the Coalition is to “reduce the uninsured rate to less than 5% in the next 5 years” they believe that “it’s more than that”.  Their initiative seeks to “increase access to healthcare, preventative care, and create real change with real peoples’ lives”.  In order to accomplish this goal the coalition mentioned that using and understanding health insurance is a multistep process.  As such, the coalition worked with different organizations and groups that would help at each step to increase health literacy.  This multilayer approach included working with physicians on communication, translating material to be disseminated in outreach, and working with community members to ensure materials were culturally sensitive.

Some of the key ingredients to their success were having an active facilitator who positively and enthusiastically encouraged participation, developing a digital drop box to make material readily available, and face to face interaction, which was vital to outreach and engagement.

A Health Literacy Workshop to Engage Community Groups

From left to right: Stan Hudson, MA, Nick Butler, MA

From left to right: Stan Hudson, MA, Nick Butler, MA

Hudson and Butler talked about their experiences leading communication workshops for patients and providers. The workshops train patients on how to be better patients and train providers on how to be better providers. Patients can include people with a certain disease, seniors, new or expectant parents, and LGBT people. Providers can include students and practicing doctors and you can tailor your case to that particular group. The presenters offered some guidelines for holding a workshop. You’ll need partners, time, travel, and money. But it can be done inexpensively, they said.

Before the workshop, you may want to:

  • Coordinate and prepare the meeting
  • Recruit a group
  • Find out what their issues are, and choose an appropriate case
  • Recruit and train people to act in role-plays
  • Train a facilitator
  • Market and promote the workshop

During the workshop, you may want to:

  • Conduct a pre-workshop survey
  • Talk about health literacy
  • Encourage learners to share their stories
  • Conduct role-plays
  • Discuss in small groups
  • Debrief in large group
  • Conduct a post-workshop survey

After the workshop, you may want to:

  • Report on the process and forms
  • Submit completed surveys

The presenters showed public service announcements about being an active consumer. The PSAs show how consumers who are happy to ask questions in other contexts can be very quiet and passive in a doctor’s office. All of us are more likely to have low health literacy during times of stress and in unfamiliar contexts. That’s why we need universal precautions. The presenters have had positive results with their workshops. “In small-group sessions, countless times, I’ve seen the light bulb go on with the simulated doctor,” said Butler. “I think there’s a lot of opportunity within the Affordable Care Act (ACA) to fund some of these initiatives.”

Reducing Unnecessary Readmissions: The New RED (Re-Engineered Discharge) Tool

Michael K. Paasche-Orlow, MD

Michael K. Paasche-Orlow, MD

Dr. Michael Paasche-Orlow discussed ways to reduced hospital readmissions. He focused on what Boston University Medical Center has done to lower these rates. He noted that under the Affordable Care Act (ACA), there are incentives for hospitals to avoid rehospitalization. The goal of avoiding rehospitalization is to improve quality and decrease cost, he said.

Hospital discharges are not standardized and are frequently of poor quality. Too often, pending test results are not followed, workups are not completed, and communication is poor. This leads to lack of follow-up care, adverse events, and readmission. This is especially true for patients with poor communication skills, he said.

“We used talk about fee for service; now we talk about fee for value,” he said. “Literacy is a part of that story. There’s a lot of work to be done to transform our organizations.”

Dr. Paasche-Orlow shared the National Quality Forum’s Re-Engineered Discharge checklist:

  • Ascertain need for and obtain language assistance.
  • Make appointments for follow-up care.
  • Plan for follow up of results from pending tests.
  • Organize post discharge services and equipment.
  • Identify correct medicines and plan for patient to obtain.
  • Reconcile discharge plan with national guidelines.
  • Teach a written discharge plan that patient can understand.
  • Reconcile discharge plan with National Guidelines.
  • Educate patient about diagnoses and medicines.
  • Assess degree of patient’s understanding of plan.
  • Expedite transmission of discharge summary to primary care provider.
  • Reinforce through telephone contact.

Studies have found that using the RED checklist is effective and saves money and he offered illustrations of how to put these items into effect.

Transforming a system takes time, and when introducing teachback, “you have to actually supervise it, observe it, and offer feedback.” When working to transform the system, Dr. Paasche-Orlow encouraged attendees to find people who will embrace the work and engage patients.

Tweets for Health: Using Twitter to Convey Simple Health Messages

From left to right: Kathleen Hoffman, PhD, MS, MSPH, RV Rikard, PhD, Alisa Hughley, MPH

From left to right: Kathleen Hoffman, PhD, MS, MSPH, RV Rikard, PhD, Alisa Hughley, MPH

Hoffman, Rikard and Hughley led a lively interactive session on using Twitter and tweet chat, to communicate with people all over the world.

Twitter is a microblogging platform to access resources you wouldn’t have otherwise — to drive people to your organization’s website, reach experts and stakeholder communities, and connect with them offline. Twitter is also a flexible up-to-the-minute news service; make it whatever you want.

The co-hosts described the culture and language of the twitterverse, including hashtags, retweets, favorites and mentions. They also conducted several activities with the audience, including how to turn a long section into an effective tweet (140 characters or less) with a health literacy focus and setting up an account on

They also discussed, a measuring company for healthcare tweets, where you can have your hashtags registered and approved at no charge. The company indicates that healthcare tweets are trending upward. Each day, there are 1 million tweets related to healthcare!