Quick Guide to Health Literacy

 Strategies

Improve the Usability of Health Services

Table of Contents

About This Guide

Fact Sheets

Strategies

Improve the Usability of Health Information

Advocate for Health Literacy in Your Organization

Resources

Navigation of healthcare and public health systems requires being familiar with the vocabulary, concepts, and processes needed to access health services and information. This includes understanding insurance coverage and eligibility for public assistance, filling out patient information forms, scheduling appointments and follow-up procedures, and locating services.

Strategies to improve the usability of health services include:

• Improve the usability of health forms and instructions

• Improve the accessibility of the physical environment

• Establish a patient navigator program

  Improve the usability of health forms and instructions

Healthcare and public health systems rely heavily on printed materials, including:

• Medical history forms

• Insurance forms

• Informed consent forms

• Patients' rights and responsibilities

• Test results

• Directions to the lab or pharmacy

• Hospital discharge and home care instructions

• Clinical research protocols and announcements

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These documents, particularly forms which contain blank spaces to be filled in by the user, are often more difficult to understand than regular prose.¹

Consent forms and other legal documents related to patients' rights often contain long sentences and difficult legal terms. It is critical that these forms be translated into plain language. According to recent guidelines prepared by the National Quality Forum, healthcare providers should ask each patient to recount what he or she has been told during the informed consent process to check for understanding.²

Tips for improving the usability of health forms and instructions:

• Revise forms to ensure clarity and simplicity.

• Test forms with intended users and revise as needed.

• Provide plain language forms in multiple languages.

• Provide clear information about eligibility for public assistance.

• Train staff to give assistance with completing forms and scheduling follow-up care.

Sample informed consent language Voluntary participation: “You don't have to be in this research study. You can agree to be in the study now and change your mind later. Your decision will not affect your regular care. Your doctor's attitude toward you will not change.” New information about risks: “We may learn about new things that may make you want to stop being in the study. If this happens, you will be informed. You can then decide if you want to continue to be in the study.” (Source: Paasche-Orlow MK. 2005. The Challenges of Informed Consent for Low-Literate Populations. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 119-140.

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  Improve accessibility of the physical environment¹

Settings with a large number of signs and postings have a high literacy demand. Maps, directions, signs, schedules, and instructions are posted throughout the healthcare setting to help consumers locate services and information. Many of these signs contain unfamiliar phrases and symbols. This environment can be intimidating and overwhelming for persons with limited health literacy skills. Too often, confusing signs and postings create more work for healthcare staff and cause embarrassment for patients.

Tips for improving the physical environment:

• Hablamos Juntos, with support from the Robert Wood Johnson Foundation, has developed a set of Universal Symbols in Health Care. Visit www.hablamos juntos.org to learn more.

  Include universal symbols and clear signage.

• Promote easy flow through healthcare facilities.

• Train staff to create and maintain a respectful and shame-free environment.

  Establish a patient navigator program

Patient navigators can help consumers access services and appropriate health information. Patient navigators are health professionals, community health workers, or highly trained patient liaisons who coordinate healthcare for patients and assist them in navigating the healthcare system. Patient navigators can help patients evaluate their treatment options, obtain referrals, find clinical trials, and apply for financial assistance.

Did you know? Congress recently passed the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005. The bill authorizes $25 million in grants over 5 years to establish patient navigator programs in low-income and rural communities nationwide. (Public Law 109-18)

¹Rudd RE, Renzulli D, Pereira A, Daltroy L. 2005. Literacy Demands in Health Care Settings: The Patient Perspective. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 69-84.

²Wu HW, Nishimi RY, Page-Lopez CM, Kizer KW. 2005. Improving Patient Safety Through Informed Consent for Patients With Limited Health Literacy. National Quality Forum. Available at http://www.qualityforum.org/docs/informed_consent/webinformed
consentMember+public09-13-05.pdf. Accessed October 13, 2005.

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U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion