Julie, Andrew,
To the discussion of provider/institution inadequate health literacy:

Many physicians and nurses and even hospital administrators readily 
admit they have a kind of "low health literacy."   And here's  one 
way I hear this:

Over the last two years I've been working with a team of talented 
people at the NYC Dept. of Health and Mental Hygiene to infuse health 
literacy principles into their Medical Detailing Kits.  The Public 
Health Detailing Program works with primary health care providers to 
improve patient care around key public health challenges. The 
Detailing Kits contain clinical tools, resources for providers and 
patient education materials to promote evidence-based best practices.
http://www.nyc.gov/html/doh/html/csi/csi-obesity.shtml

One of the goals of the kits is to advance the health literacy of 
providers and patients.

As part of each kits development my team conducts broad ethnographic 
health literacy investigations - interviews countless providers and 
experts, as well as talking to consumers/patients about the topic at 
hand.
The most recent kits - Adult Obesity - Intimate Partner Violence - 
demonstrated aspects of inadequate provider health literacy 
-something they readily discuss:

Here are some examples:

    Providers report that they don't have effective verbal skills to 
communicate importance of weight loss to their obese patients - "I've 
simply run out of words."    (Fundamental/Verbal Literacy)

    They often don't know how to translate complex science into 
relevant action that they can take to educate their.  "All I can do 
at this point is treat her diabetes, and I'm not doing that very 
well." (Science literacy)

    They lack confidence in their ability as physicians to be 
effective in talking to their patients about nutrition - " I wasn't 
trained in this.   I don't know much about it."(Cultural Literacy)

    They know how to work with numbers but they are stymied by some of 
the epi data relative to on-the-ground realities of what they see 
with their patients. (Numeracy/Fundamental Literacy)

      They have a hard time judging some of the contradictory 
scientific evidence  - "I'm not convinced that collecting BMI on the 
kids is going to do much.  Is anyone?"  (Science Literacy)

      They haven't found ways to compensate ( and they don't' think 
they will) for an inadequate health care system.  "Educating the 
patient and really making a difference takes more time than my 
practice would ever have. (Civic Literacy)

So, just what part of this isn't low health literacy?

Chris


-- 
Christina Zarcadoolas, PhD.
Assistant Professor
Health and Environmental Literacy Initiative
Dept. of Community and Preventive Medicine
Mount Sinai School of Medicine
One Gustave L. Levy Place
Box 1057
New York, NY 10029
212-824-7061

Visit my blog     www.zarcbark.blogspot.com
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