Article from the Boston Globe’s On Call Magazine, December 2001

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Chronic illness affects about 100 million Americans, and the number will grow to 134 million Americans by the year 2020. For their own well-being, patients who have a chronic illness often need to assume responsibility for their care and treatment on a daily basis. That means healthcare professionals need to know how to get across the information patients need before they need it.

In most instances, patients with chronic illnesses —sometimes with the assistance of family members or caregivers — assume the bulk of the responsibility for handling their day-to-day treatment and care. To fulfill this responsibility, patients need to know not only about medication, nutrition, exercise, and self-care, but also how to recognize a medical emergency and respond appropriately should one occur.

For example, Sally has diabetes. In addition to needing to know the facts about this condition and how it affects her body, she also needs to be able to carry out self-care tasks. This means Sally must know how to monitor her own blood sugar levels, take or adjust her medication as needed, and call her provider when she has questions or concerns. She needs to understand how to eat properly and how to integrate exercise into her daily routine. She may also want to know where to look to find out more about diabetes from books or magazines, from the Internet, or from community-based educational programs.

Healthcare providers can best help patients like Sally by ensuring that they provide information in ways that match how the patient learns, by confirming that the patient understands the information, and by offering additional resources the patient can use for ongoing education and support. In my new book, Partnering with Patients To Improve Health Outcomes, I offer practical ideas and strategies providers can use to accomplish these goals.

Apply Principles of Adult Learning

Although not every patient encounter is a formal educational meeting, each one does provide an opportunity for teaching and learning. To take advantage of these opportunities, you should be sure you present information in a way that is appropriate for the age and learning approaches of your patient. Here are some strategies from Malcolm Knowles’ book, The Adult Learner: A Neglected Species, for working with young to middle-aged adults.

• Encourage patients to work with you in setting the educational agenda. One way to do this is to work together to decide what topics need to be discussed at once and which can wait until the next meeting. This usually means focusing on the topics that are of immediate concern to the patient and then scheduling additional appointments to cover the rest of the information you need to present.
• Provide information that is practical and relevant to the patient’s daily challenges and experiences. Ask what a patient finds difficult and adapt your teaching accordingly. Sally, for example, finds it very difficult to follow her food plan while she is away on business trips. Help her learn practical ways to make healthy food choices whether she’s at home or in a restaurant.
• Compare and contrast new information with what the patient already knows. When you teach a new procedure, compare it to tasks that the patient is already familiar with. For example, when you introduce a new glucose monitor, let the patient know how this device differs from the one he or she has used in the past.

Confirm That Information Is Understood

During each appointment, as well as over a series of sessions, make sure that patients truly understand the information you discuss.

• Ask patients to tell you how they understand directions. Confirm understanding and short-term recall by asking patients to repeat back, in their own words, what you just told them. Similarly, when you teach patients a new procedure, ask them to show you how they will accomplish this task at home.
• Follow up. To assess longer-term learning, call patients a few days after a teaching session. Ask how they are managing at home, making sure they not only remember the key concepts but also can carry out the instructions needed for self-care. If there seems to be a problem, suggest the patient come back for a follow-up teaching session.
• Involve others. If a patient seems to have difficulty understanding or remembering information — either on a short-term or long-term basis — consider involving others (with the patient’s permission, of course) in the teaching session. This way, family and caregivers can help make sure the message is understood and correctly followed.

Offer Additional Resources

Providers generally communicate healthcare information verbally. To make your teaching more effective, find at least one other way to communicate. Augment your teaching, for example, by using written materials, audio or videotapes, or resources from the Internet. As appropriate, encourage patients to participate in health-related programs in the community.

The challenge for you and patients alike is to make sure that these additional resources and programs are useful, accurate, and up-to-date. One way to approach this task is to compile lists of worthwhile materials and resources. For instance, publish a list of print and Web-based resources you feel are credible and likely to be of value to your patients. Make sure you include the date that you either created or last reviewed this list. Then, periodically review the publications and Web sites on your list and double-check that they still meet patients’ needs.

You can also make lists of community groups, classes, and educational programs. Many community organizations offer health-related programs. Find out about resources in your local area, including not only ones at healthcare facilities but also programs sponsored by health clubs, civic and religious groups, and even the public library. As with the list of print and Web materials, date your list and review its appropriateness periodically.

Learn what resources patients find valuable. Ask patients about their experiences with the materials and programs on your lists. Invite them, as well, to let you know about other resources they find helpful. By working together as partners, you can help patients with chronic illnesses acquire the skills, knowledge, and resources they need to manage their day-to-day healthcare responsibilities.

How to Find Out More

This month’s column was adapted with permission from: Osborne H. Partnering with Patients To Improve Health Outcomes. Gaithersburg, MD: Aspen Publishers;2001. To order the book, call Aspen at (800) 638-8437 or visit their website www.aspenpublishers.com

Helen Osborne, M.Ed., OTR/L is president of Health Literacy Consulting in Natick, MA. You can reach her by e-mail at helen@healthliteracy.com or by phone at (508) 653-1199. You can also visit the Health Literacy Consulting Web site at www.healthliteracy.com

Additional Resources

• Institute of Medicine. Crossing the Quality Chasm. Washington, DC: National Academy Press; 2001.
• Knowles M. The Adult Learner: A Neglected Species. 4th ed. Houston: Gulf Publishing Company; 1990.