Strategies to improve health literacy: plain English and teach back - PowerPoint PPT Presentation

Strategies to improve health literacy: plain English and teach back Claire O’Riordan, NALA 4 March 2016

What I am going to cover  Definitions of teach back and plain English  Support for each strategy  Tips for using both strategies Why? Teach back and plain English can improve:  your communication skills,  patient safety, and…  health literacy .

Do you find it hard to communicate clearly?  Relaying all the information that you have to relay  Finding the time to explain and or discuss a condition or treatment fully  Simplifying complex or confusing medical concepts  Not to overestimate a patient’s knowledge and or ability to retain information 3

Do you know that patients can sometimes find it hard to understand you?  Worry / fear  Pain  Lack of confidence  Low retention skills  Sedating meds  Literacy difficulties (1 in 6 low literacy; 1 in 4 low numeracy skills)… 4

Ways To Make Things Clearer (MSD 2015) Research)Something To Patients Q.7 In what way/s do you think GPs, hospital doctors, pharmacists or nurses could make things clearer for patients when they are explaining something to them? *Answers  1% not shown As with the survey in 2007, using less medical terminology helps patients’ understanding. While 17% of respondents don’t know how HCPs could make things clearer for patients. Interestingly, this response is more common among men than women. [ Research commissioned by MSD in association with NALA. ] Base: All Respondents: 1,000

What is teach back?

What is teach back? ● Asking patients to repeat in their own words what they need to know or do. ● Use when checking for understanding about a patient’s understanding of their: ● medical condition, ● treatments, and or ● self-care. ● A chance to check for understanding and, if necessary, re-teach the information. 7

Why? • Assures you that your message has been understood • Helps people who want less medical jargon (39% called for it – MSD 2015) • Stop people take wrong dosage of medicines (17% - MSD 2015) • Avoid embarrassment – as we saw just now. 8

Evidence of benefits  Becoming more popular based on support of research and usage in NHS in Scotland, in the US…  Patients, who have a clear understanding at discharge, are 30% less likely to be readmitted or visit the emergency department than patients who lack this information, according to a study funded by the Agency for Healthcare Research and Quality (AHRQ) and published in the Annals of Internal Medicine.

When to use teach back  New/change meds  Care planning  Informed consent  Showing patients how to use equipment such as a glucose measuring device  Follow up calls… Think of a situation where you can use teach back

Tips for using teach back  Prepare! – what are you going to say to your patient? Example: “Mr Clooney, can you tell me why you are in the hospital?” [Don’t ask ‘Do you understand?’ Keep questions open]   ‘Chunk and Check’  Clarify and check again  Start slowly  Show- me how to…  Use handouts with teach-back.

What is plain English?

What is plain English?  Plain English is a way to write and present information so a reader can understand and act on it after a single reading.  Plain English means: − writing accurately and clearly for the intended reader, − avoiding jargon, except for people who will understand it − using clear layout and design so the information is easy to read. 13

Plain English checklist for documents This checklist offers a quick way for you to review a letter, leaflet, booklet or short report to see whether it uses plain English and is easy to follow. Not all questions will apply to every document, by try to answer ‘yes’ as much as possible to the questions that do apply. Language, punctuation and grammar Yes No 1 Does the document use ‘you’ and ‘we’, where possible? 2 Does it use the active voice most of the time? 3 Does it keep technical terms and abbreviations to a minimum? 4 Does it define any necessary terms and abbreviations clearly? 5 Does it keep ‘corporate jargon’ to a minimum? 6 Does it avoid Latin and French phrases and Latin abbreviations? 7 Does it use the same term for the same concept throughout? 8 Does it have an average of 15 to 20 words in each sentence? 9 Does it use the simplest verb tense possible? 10 Does it avoid abstract nouns where possible? 11 Does it use correct punctuation? 12 Do nouns and verbs agree (singular noun with singular verb, for example)? Structure 13 Does it organise information according to the reader’s needs and interests? 14 Does it use informative headings or questions to break up text? 15 Does it include a natural flow from one point to the next? 16 Are paragraphs relatively short? 17 Does it use bullet point lists for detailed or complicated information? Page design 18 Does it avoid underlining, groups of italics and unnecessary capital letters? 19 Is text in a readable typeface (font), aligned to the left and 1.5 spaced? 20 Are images, charts or blocks of colour, if any, clear and relevant to the text?

Where is plain English used? Ireland Abroad The Director of Corporate US Plain Writing Act,   Enforcement 2010 Health Information and Canada: government   Quality Authority communications policy, Health and Safety 2012  Authority UK: Office of Fair Trading  CORU European Commission:   PCRS – under 6s Medical Clear Writing campaign  Card Form Some hospitals 

Benefits of plain English  It improves accountability and compliance.  It is more precise and legally sound than less comprehensible English.  It can help people save time and money.  It improves the general standard of writing.  It gives everyone a fair chance to access essential services. 16

Evidence of benefits  The Royal Mail saved £500,000 in nine months by redesigning just one form.  When Arizona’s Department of Revenue rewrote one letter in plain English, it got about 11,000 fewer phone calls than the previous year.

Evidence of benefits  In a study to test understanding of medical consent forms in the US, readers of the original form could answer correctly only 2.36 questions out of 5. Using the plainer form they got 4.52 questions right, a 91% improvement; they also took less time to answer.

Plain English Guidelines

Be direct – use the active voice Guidelines 1-2

Be direct (subject – verb – object) Before The request will be considered by the Authority. After The Authority will consider the request.

Be direct Before All details should be included (by you). After You should include all details.

Use positive and assertive language (not in the guidelines but I will add!)

Be positive...  Sentences should assert  Say what is – not what isn’t  Try to express negativity in positive form

Use everyday language Guidelines 3-7 inclusive

Use everyday words Why use a long word when a short word will do? For example: Instead of Use catheter tube immunise protect negative (test results) you do not have, you are not If you must use specialised language or jargon, explain what it means.

Be concise Guideline 8

This sentence has 59 words In circumstances where a patient subject to an involuntary admission order is deemed to require ECT in order to ameliorate his/her condition or to safe guard the life of the patient and restore his/her health a second opinion is sought from the consultant psychiatrist (who is demonstratively independent and on the panel drawn up by the HSE).

Now, the information is divided into two sentences (37 words) If the consultant psychiatrist believes that an involuntary patient requires ECT to improve their condition or to safeguard their life, the opinion of a another independent consultant psychiatrist is sought. This consultant must be on the HSE panel. 29

Make your verbs obvious Guidelines 9 and 10

Making verbs obvious  conduct an analysis  present a report  do an assessment  provide assistance  come to the conclusion 31

Before (25 words) They will conduct an investigation into the failure of the system and then make a decision about when the publication of findings should occur. 32

Rewrite (15 words) They will investigate why the system failed and then decide when to publicise the findings. 33

Punctuation Guideline 11

Differences Let’s eat granny. Let’s eat, granny. 35

Noun and verb agreement Guideline 12

Noun and verb agreement The dog is barking. The dogs are barking. The consequence of over-eating and lack of exercise after a long period of time are that general health suffers. Longer sentences make it harder to see Disagreement. Can you see it? 37

Structure and design Guidelines 13-17

Use lists Before: If you send us a letter, fax or email we endeavour to acknowledge receipt of all such correspondence within 5 days of receiving same and ensure that a substantive reply to a query will issue within 20 days where information is readily available.