Improving patient outcomes through health literacy

Posted Date: May 22, 2017
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The prescription bottle said, “Take one tablet as needed,” so the patient did – repeatedly – going far beyond the recommended daily dosage.

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Left to right, Dr. Wagner with State Senator Diana Arevalo and Chris Yanas, Director of Governmental Affairs, Methodist Healthcare Ministries of South Texas

A health information pamphlet for teens titled “Adolescent Transitional Care Policy” became much clearer when given the new headline, “You’re Becoming an Adult!”

In another example, plain language, photos and illustrations were found to better communicate how to take and store strong oral chemotherapy medicines that depend on closely following the directions.

“Every day across the U.S., patients are confused by or misinterpret healthcare instructions, sometimes leading to very dangerous results,” said Teresa Wagner, DrPH, MS, CPH, RD/LD, health literacy advocate and Adjunct Assistant Professor with the UNT Health Science Center School of Public Health.

“With health forms and instructions written well above the average adult reading level, it’s no wonder most Americans find health information complicated and confusing,” she said.

Concurring with Dr. Wagner are findings from the Institute of Medicine, reporting that more than 90 million adults today have limited skills in reading and math, considered necessary tools for understanding and following basic health information.

Health literacy, simply defined, is being able to obtain, use, understand and navigate health information, instructions and resources.

For quite some time, Dr. Wagner has been working to increase health literacy awareness across Texas, speaking earlier this year at a Medicaid conference, providing trainings across the state, and most recently, speaking to legislators in Austin on behalf of a bill she championed to improve health literacy, access to care and patient outcomes.

“If passed, House Bill 3682 would be the first document to legally recognize the issue of health literacy in the state, and the long-term effect could improve the health of citizens and potentially save Texas millions of dollars in healthcare costs,” she said.

Sponsor of the bill is State Representative Diana Arevalo from San Antonio, with support from Methodist Healthcare Ministries of South Texas and the Texas Dental Association.

“Low income families, the elderly and new immigrants are most likely to suffer from health literacy challenges,” Dr. Wagner said, “greatly impacting prevention and control of health conditions. Language and cultural differences can also change interpretation and translations, giving different meanings than what may be intended.”

“It’s important to find ways to bridge communication gaps among the healthcare system, providers, patients, their families and caregivers,” she said.

A registered dietitian, Dr. Wagner works directly with patients and consults with health providers to empower individuals to take an active role in their personal wellness plan. Health literacy, she says, is key in this process.

“When the doctor’s advice is for a patient to ‘eat healthier,’ what does that mean? Patients need a good understanding of how to shop for and prepare healthy foods, and how to make the best choices, as well as how to talk with doctors, nurses and others about their conditions, questions and concerns,” she said. “Those providers can then refer inter-professionally, so that experts in each area can address patient needs in a health literate manner.”

“I have seen so many patients unsure of how to be proactive in their own care by simply asking questions, people who have stopped taking their medicines because they didn’t feel comfortable talking to the pharmacist, or who didn’t understand health or nutrition instructions but were afraid to ask.”

“Even making a doctor’s appointment can be a challenge when it comes to navigating websites and completing forms online,” she said.

Dr. Wagner was first drawn to health literacy while pursuing her DrPH at the UNTHSC School of Public Health, when she began working as a graduate assistant on a health literacy research project for the United Way of Tarrant County.

She then chose to complete her doctoral residency at the University of Texas Center for Health Communication and the Literacy Coalition of Central Texas (LCCT). She was subsequently hired as the LCCT’s Director of Health Literacy, leading to her work that continues in this area today.

This fall, part of her appointment will be with the UNTHSC Institute for Patient Safety, leading health literacy efforts. These efforts will address general health and wellness information, as well as emphasize health literacy as a factor in patient safety.