Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. Health literacy is based on various factors such as:
- Communication skills of lay persons and professionals
- Lay and professional knowledge of health topics
- Demands of the healthcare and public health systems
- Demands of the situation/context
The level of health literacy impacts a patient’s ability to:
- Navigate the healthcare system, including understanding health insurance coverage, filling out complex forms, and locating providers and services
- Share personal information with providers, including health history and lifestyle (diet/exercise) information
- Engage in self-care and chronic disease management, including tracking/attending medical appointments and understanding medication-taking regiments
- Understand mathematical concepts such as probability and risk in order to make informed decisions about treatment options
Providers need to increasingly grasp a patient’s level of health literacy in order to “prescribe” how a patient can best manage his/her health. The success of health system reform will depend in large part on the capacity of individuals, families and communities to make informed decisions about their health.
Making informed decisions requires understanding the communications with healthcare providers. However, many communications fail in their ability to reach and resonate with patients and their family caregivers. Using Census Bureau data, the Center for Immigration Studies reports that 67.3 million residents in the United States, or 22 percent of the population, now speak a language other than English at home and around 8% of the U.S. population is defined as Limited English Proficient (“LEP”). Communication problems are among the root causes of 59% of serious adverse events reported to the Joint Commission’s Sentinel Event Database (The Joint Commission, 2012), and research suggests that LEP patients are more likely than English-speaking (ES) patients to experience safety events caused by communication errors.
English-only healthcare communications can be limited in their impact with patients who primarily speak or prefer a language other than English for their day-to-day communications. For patients with limited English proficiency, linguistic and cultural barriers can result in misunderstandings regarding diagnosis, treatment, and self-care. Medication management instructions and follow-up care plans might not be fully understood, resulting in gaps in compliance and adherence. There may be a hesitancy to ask questions for clarification or request assistance with emerging conditions, resulting in an exacerbation of chronic conditions which can lead to a rehospitalization. These scenarios can lead to lower patient satisfaction and worse outcomes for LEP patients.
According to a report issued by the UCLA Latino Policy and Politics Initiative and the UCLA Health Center for the Study of Latino Health and Culture, “culture, needs, and population demographics must be taken into account” when designing and implementing telehealth. In the example of California, the report’s authors indicate that the state’s Latino community must be core to the development of technological interventions:
- As nearly half (44%) of the population speaks a language other than English at home, “medical interpretation will need to be systematically incorporated into telehealth.”
- The healthcare system should “enables our most vulnerable patients to seek and receive remote care with any and every modality available to them.”
Overlooking the role of interpretation in a virtual care platform can unfortunately raise another barrier for the LEP patient population. Real-time access to interpretation during virtual visits will help all patients better understand their condition and follow-through on their treatment plan. A virtual care communication platform allows a home health clinician to quickly include an interpreter into a video call in order to ensure that the patient fully comprehends the care being provided and the expectations going forward. Innovative platforms provide clinicians with the ability to easily include medically qualified video interpreters for LEP as well as Deaf & Hard of Hearing patients.
Ongoing messaging can also be translated into the patient’s primary or preferred language to deepen patient understanding and engagement. Translated emails and text messages can provide ongoing medication, dietary, exercise, and general health guidance to drive adherence and compliance.
All communications should be designed and deployed with the objective of improving health literacy, matching patient preference in culture, language, and tone, and ensuring that providers and patients are aligned in the treatment plan.
Successful home health agencies are able to deliver the best care — meaning, care that is timely, responsive, and appropriate (linguistically and culturally) for each patient and their respective family/home situation — in the post-acute stage with virtual care. Referral sources also value home health agencies who better engage patients who are part of the LEP population and can check on patient progress and reinforce the treatment plan while elevating the patient experience. Virtual care platforms can help providers more efficiently (and effectively) enlighten all patient populations and drive deeper levels of health literacy.
AnnaMaria Turano is chief marketing officer for Synzi.