Helen: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.
In these podcasts, you get to listen in on my conversations with some really remarkable people, hearing what health literacy is, why it matters and ways all of us can help improve health understanding.
Today I’m talking in person with Susan Reid, who is a consulting manager at Workbase, a not-for-profit specializing in workplace and health literacy based in Auckland, New Zealand. Welcome, Susan.
Susan: Kia ora, Helen, and thank you very much for this opportunity to talk to you.
Helen: You and I have known each other for quite a while. I know there’s a concept I know that’s especially important to you. That’s about meeting people where they are at when you do health teaching. Let’s take it from the beginning. What is important about meeting people where they are at?
Susan: It comes from my work in literacy. I’ve been involved in literacy for a long time. There’s something in reading theory called schema theory. It’s a frame that psychologists use. Basically, everybody has stuff in their head. They’ve learned something from when they were little all the way through.
Starting off where people are at and finding out what they know, feel or believe is really important in literacy, particularly in reading. It’s exactly the same in health because if you find out what people know, believe or feel, it’s going to make it much easier for you as a health professional to make a decision about how much information you give somebody and how you deal with their feelings or beliefs.
Helen: Give me an example. Yes, we need to know what people believe. How does that fit in with teaching about health or medicine?
Susan: For example, I’ve done a lot of work in New Zealand on gout. It’s quite a big issue over there. When I was talking to men about gout and said, “What do you think causes your gout?” they would say that what caused their gout was the food they ate and alcohol. They’d say, “It’s what I eat and drink.”
Actually the medical reasons for gout are because people have excess uric acid in their blood. In New Zealand, the Maori and Pacific people have a gene that actually holds onto the uric acid instead of getting rid of it through the kidneys.
Helen: I didn’t know that.
Susan: Nor did they, so here they are blaming themselves because they’re eating the wrong foods and drinking alcohol. We’re saying to them, “Actually, it’s about your uric acid. If we deal with your uric acid and help your body get rid of your uric acid, you can eat a bit more of those foods you like.”
Often they exclude those foods from their diet and really don’t enjoy their life. We’ll say, “Let’s deal with the uric acid,” and they can have a few more of those foods they like.
Helen: You’re teaching people about gout. You have a lot to teach. It sounds like there are some myths as to what this is about. Clue us all in. How would you go about finding out what someone really knows or believes to be true before you do your teaching?
Susan: For gout and others, the issue is about medication. Often if I’m doing some patient education with someone, I’ll say, “Tell me what medications you’re on.” If they say, “I’m on a statin,” I’ll say, “Tell me what you know about your statin. They’ll say, “It’s my pink one or blue one,” or they might actually know the name of it and that’s great.
Then I get an idea that they know a little bit about their medicines. If they say to me, “I’m on a statin that’s called Lipitor and my statin is to reduce my cholesterol so that it protects my heart and I don’t end up having a stroke or heart attack,” I realize they know quite a lot more about their medicine. Therefore I don’t have to add as much.
In health, we often assume people know nothing, so we tell them a whole heap of stuff, or we assume they know everything and we don’t tell them enough. If you ask people at the beginning what they know, think, feel or believe, you’re going to get more information out.
That helps you as a health professional to make a decision about how much information you give and link it in to what they know. If I was talking to someone about their medicine, I’d say, “That’s really great that you know those things about your statin. Here are some other things we could talk about. Here are the side effects you get from your statins.”
Helen: That’s neat to start that way and not just base it on our own assumptions. I know in the US, sometimes they might come in with a protocol like we need to teach about pathophysiology, medication and home care, but you’re saying we can skip some of those steps perhaps. Is that correct?
Susan: Absolutely. If we find out what people know. I always tell people to think about when somebody tells you something you already know and your mind drifts away. You start thinking about what you’re going to be doing next and you don’t actually hear what the person is telling you, or you get a bit irritated and think, “Why are they telling me that? I already know that. Do they think I’m dumb or silly?’”
I think asking people what they know does three things. First, it shows an interest in people.
Second, it helps you as a health professional decide if I can give this person more information or if they are actually at such a basic level of understanding or belief about this that I can’t do that program I had in mind. I’m going to have to do it in chunks, and I can do a bit today.
The third thing it does is show the patient that you’re trying to personalize it for them. It’s not a square peg that you’re trying to ram into a round hole. You’re saying, “I’m interested in you, and I’m going to try to do what I want to share with you for you. It’s not for anyone else, but actually for you and your family members who may have come with you.”
Helen: It sounds like an efficient use of time too because we’re always so pressed for time.
Susan: I know. That’s one of the most common things I come up against when we talk about it in New Zealand with health professionals. They say, “We haven’t got time to do this.”
Actually, if you do it well, it shortens your time because you’ll find people who do know quite a lot, or you’ll find out that they know such different things that whatever you tell them was wasted last time.
You’re frustrated and thinking, ‘Why aren’t they getting this? I’m explaining it clearly and doing all of these things,” but actually it doesn’t link to what they already know. Therefore, you’re wasting your time. We do try to push that efficiency and effectiveness in relation to these conversations.
Helen: That’s good. I want to ask about the effectiveness in a moment, but first I want to find out some of that how-to stuff. You’re asking the professionals to teach in a little bit different way than they’ve been teaching before. What kind of words would we use? Make it real for us.
Susan: For instance, I just say, “What do you know about your medicines? What do you know about this test you’re having? What do you know about your diabetes?” If you think they might be a bit nervous or upset, you can say, “How are you feeling about this?” or, “How do you think this is going to make things better for you?” or, “How do you think this is going to affect you?”
It’s an open question about what they know. It’s asking them not just to give a yes or no or a very particular answer, but using a nice, open question. Then the next big thing is to sit and say nothing, wait for them to answer and not answer it for them.
Helen: I always try to do that. It’s hard to do the listening when we’re so used to doing the talking. Tell us now about effectiveness. Does this work?
Susan: We’ve just finished a study about medications. It hasn’t been published yet. In the data, we had a framework for asking people about one of their medicines. They needed to know nine things. When we first asked them at the beginning of the session, they knew three out of nine.
We used the framework at the end with exactly the same questions and said, “We’ve talked about your medicines today and we’re going to now ask you these things. What do you know? What is your medicine called?” People went from knowing three things to knowing eight out of nine in one session.
Susan: That’s an important thing about having a frame and believing that people are able and interested to learn. Sometimes as health officials we get a bit jaded about it and think that people aren’t interested, but people do want to learn about their health and their medicines.
Helen: You’re really taking us from the very beginning of that conversation. “What do you know? Let’s talk about what you need to learn.” Thank you for doing this for listeners of Health Literacy Out Loud. We’re all adding to that story.
Susan: Thank you so much. Kia ora.
Helen: I learned so much from Susan Reid. What a great reminder about the importance of considering the other person and what he or she already knows and believes to be true. That’s all part of health literacy.
But health literacy isn’t always easy. For help clearly communicating your health message, please visit my Health Literacy Consulting website at www.HealthLiteracy.com. While you’re there, sign up for the free monthly enewsletter, What’s New in Health Literacy Consulting.
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Did you like this podcast? Even better, did you learn something new? I sure hope so. If so, tell your colleagues and friends. Together, let’s let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.