How-To Tips

Health Literacy

Continuum of Care

Apr 1, 2022

Health care can happen in many settings, at different times, and with almost infinite pairings of patients, caregivers, and providers. In other words, health care today can happen at all stages of what is commonly referred to as the “continuum of care.”

For simplicity’s sake, I divide this continuum into four stages, each with distinct tasks and communication challenges. These can occur in any order or even overlap. I refer to these as wellness, access, illness, and self-care. Here is a brief look at each, along with examples of ways to help.

Wellness includes personal choices that support good health. These include choices about food and activity. Wellness also is about deciding whether to get a screening test (like routine mammogram or prostate exam). Here are two strategies to try:

  • Teach how today’s decisions might matter later on. It can be tempting to eat a gooey dessert rather than fruit. Or binge on movies rather than take a walk. In the short term, the more tempting option might not cause harm. But the cumulative effect could affect health. Help by teaching how today’s decisions can have long-term consequences.
  • Explain benefits and risks of routine screening tests. Screening tests look for early signs of a disease, before noticeable symptoms. While screening tests offer great benefits, there also can be harms such as the risk for overdiagnosisand overtreatment. Explain clearly how these tests can help along with their potential risks.

Access. This includes how patients (or family and caregivers) can determine the urgency of a medical problem and decide where to go for care. Here are two ways to help: 

  • Offer triage advice. Many of us have choices about where to go for care. How can someone who already is not feeling well make the right choice from these options? One way to help is by having a “hotline” number to call for advice about where to get needed care.
  • Teach ahead of time what to do should problems occur. Hours after being treated for a medical problem, I noticed concerning symptoms. I was very appreciative of the written handout that I received earlier that day about possible problems and what to do should they occur. 

Illness. There is a lot to communicate when someone is sick. This includes diagnosis (what is wrong), prognosis (what to expect), and options for treatment and care. Here are a few strategies to help:

  • Explain diagnosis. Many conditions are hard to see. Beyond just talking, consider writing relevant details on an anatomic illustration, sharing a video, or showing the condition on a lifelike plastic model. 
  • Explain prognosis. This includes risks and probabilities about what may lie ahead. The hope is that patients will use information about their prognosis to make informed choices about treatment and care. 

Self-care. The reality is that most care happens when patients are on their own, without immediate guidance from health professionals. Here are two of many useful strategies: 

  • Explain what patients need to do. This can include clear written instructions, hands-on practice, and illustrations of needed actions.
  • Make it easy for patients to schedule and keep appointments. Online patient portals are an increasingly popular way for patients to make medical appointments. But not everyone has online access or wants to use it. Provide phone reminders and appointment cards, too.

This How-To Tip is adapted from Helen Osborne’s book, Health Literacy from A to Z: Practical Ways to Communicate Your Health Message, Third Edition.