Return-Path: <nifl-health@literacy.nifl.gov> Received: from literacy (localhost [127.0.0.1]) by literacy.nifl.gov (8.10.2/8.10.2) with SMTP id h8OGjoV07986; Wed, 24 Sep 2003 12:45:50 -0400 (EDT) Date: Wed, 24 Sep 2003 12:45:50 -0400 (EDT) Message-Id: <006101c382ba$188fa1a0$fa8c2344@montbl01.nm.comcast.net> Errors-To: listowner@literacy.nifl.gov Reply-To: nifl-health@literacy.nifl.gov Originator: nifl-health@literacy.nifl.gov Sender: nifl-health@literacy.nifl.gov Precedence: bulk From: "Audrey Riffenburgh" <ar@plainlanguageworks.com> To: Multiple recipients of list <nifl-health@literacy.nifl.gov> Subject: [NIFL-HEALTH:4155] Re: "Health literacy" out "Clear Health Communication" in X-Listprocessor-Version: 6.0c -- ListProcessor by Anastasios Kotsikonas X-Mailer: Microsoft Outlook Express 6.00.2600.0000 Content-Transfer-Encoding: 7bit Content-Type: text/plain; Status: O Content-Length: 6054 Lines: 146 Dear Ian, Like you, I have not seen any literature specifically relating health outcomes to low health literacy in skilled readers (who may be very ill, scared, etc.). However, wouldn't this issue be the same as basic patient/physician communication challenges? If a patient with adequate literacy skills doesn't understand the medical terms, diagnosis, or treatment plan, wouldn't that increase the chances of lower compliance, more medication errors, etc. as it does with patients with inadequate literacy skill? Obviously, people with limited literacy skills will be more seriously affected by their inability to decipher information from their doctors but I do believe poor health communication affects us all. In my own experience a while back, a doctor instructed me to taper off one medication and transition on to another. He went over the instructions very quickly and I took notes very quickly. I followed the plan exactly as I had written it. A month later I was having some bad side effects and had to go back to see him. It turns out that he had neglected to tell me one very important step. My HMO had to incur the cost of an extra visit to straighten it out. Similarly, my father has been very ill with repeated bouts of pneumonia this last year. He was told not to drink too much fluid by one doctor but was told to increase fluids by another. Confused and sick, he went home and began to increase fluids. He ended up back in the ER with some heart problems related to his electrolytes and fluid. I didn't get the whole story because he couldn't understand what the doctor said so he couldn't tell me later. Seems these kinds of situations happen every day but are just not as easy to tie to poor communication as are the situations where the patient has low literacy skills and really missed the message. Audrey Riffenburgh, M.A. President, Riffenburgh & Associates P.O. Box 6670, Albuquerque, NM 87197-6670 Phone: (505) 345-1107 Fax: (505) 345-1104 E-mail: ar@plainlanguageworks.com Specialists in Plain Language & Health Literacy since 1994 ============================================= Principal & Founding Member, The Clear Language Group www.clearlanguagegroup.com ----- Original Message ----- From: "Ian Bennett" <ibennett@mail.med.upenn.edu> To: "Multiple recipients of list" <nifl-health@literacy.nifl.gov> Sent: Tuesday, September 23, 2003 4:21 PM Subject: [NIFL-HEALTH:4151] "Health literacy" out "Clear Health Communication" in > Hiya Audrey, > Points well taken. > I do think we should be clear though that I am not aware of any evidence > that an adult with good reading skills (as measured by literacy instruments > including the REALM and TOFHLA) but have some difficulties with issues in > the health literacy domains have negative health outcomes or cost the > health system anything (maybe it does but we just don't have any data on > this). When we talk about the data that health literacy and health outcomes > are linked we are actually talking about literacy and health outcomes. > That is not to say that we should get doctors to speak more clearly, we > should, and it will benefit everyone. > Ian > > Greetings, Ian and other "listers": > > I read your post about the term "clear health communication" with > interest. I attended the Pfizer Health Literacy conference in DC last week, > too, and, personally, I was glad to see the new term in use. My colleagues > in the Clear Language Group and I have been working with Pfizer on its > health literacy initiative since its inception 6 or 7 years ago. We have > talked quite a bit with Pfizer about our concerns that the focus on people > with low literacy skills was too narrow. I am glad to see the new term > coming into wider use. > > I came into my health literacy work from the adult literacy field (I've > worked at the local, state and national level). I am VERY aware of the huge > challenges these people face and I don't want to dilute the attention given > to them. At the same time, I felt that framing the problem as mainly a > "literacy" issue rather than a lack of plain language usage by health care > professionals was problematic. I always felt that focusing on people with > limited overall literacy skills put the responsibility for lack of > communication at their feet. It laid too much blame on them, especially > when we talked about how much low HEALTH literacy costs the medical system. > Instead we need to put more of the responsibility for communication on to > health care providers. I also think that if we are talking to health care > providers about 20% of US adults, it's harder to get their attention. They > can more easily dismiss the information by saying, "I don't have any of > those people in my practice." Whereas framing the issue in a larger context > can help those providers understand the serious scope of the problem. > > I think we must continue to speak out about the challenges people with low > overall literacy face, the impact of low literacy skills on their health, > etc. I don't believe they will get lost in the transition. I think > widening the focus may even help them more than the current view. I like > reframing the issue in the new way because it helps health care providers > and people who develop print materials understand the responsibility which > is rightly theirs in the communication process. It' s not just about people > who struggle to read. It's about how difficult it is for ALL of us to > understand and use health information when it's presented in such a way > that the general public can't make sense of it. > > I look forward to hearing others' perspectives on this issue. > > Audrey Riffenburgh, M.A. > President, Riffenburgh & Associates > P.O. Box 6670, Albuquerque, NM 87197-6670 > Phone: (505) 345-1107 Fax: (505) 345-1104 > E-mail: ar@plainlanguageworks.com > Specialists in Plain Language & Health Literacy since 1994 > ============================================= > Principal & Founding Member, The Clear Language Group www.clearlanguagegroup.com > >
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