role in the institute’s health care literacy campaign “by not ordering and recom- mending things that cost a lot of money that have not proven to be effective.” In the meantime, many physicians
are taking steps to improve health lit- eracy among their patients. Dr. Carter says he tries to establish a level of trust with his patients so they look to him as a source for medical information and advice, rather than to a controversial website. “After that, we can start to try to edu- cate during every visit,” he said. In a 2006 report, The Health Literacy of America’s Adults: Results of the 2003 National Assessment of Adult Literacy, the National Center for Education Statistics
measured the health literacy of U.S. adults using four performance levels. Fourteen percent of those measured had a below basic understanding of health care, 22 percent had a basic understand- ing, 53 percent had an intermediate understanding of health care, and only 12 percent of the population was rated proficient. The full report is available at
http://nces.ed.gov/pubs2006/2006483. pdf. (See “U.S. Adult Health Literacy Rate, 2003,” page 47.) Emergency medicine physician Parin
Shah, MD, a 2013 graduate of TMA’s Leadership College, says these statistics left him speechless. “I was astonished to find out that our national adult health literacy rate is only
12 percent. That means nine out of 10 people will walk out of a doctor’s office not understanding the health concern,” he said. “That’s completely changed the way I’ve practiced.” Dr. Shah, past president of the Fort Bend County Medical Society, says he is thrilled TIHCQE chose to promote health literacy.
In his own practice, Dr. Shah goes the extra mile to make sure patients don’t just nod their head and walk out the door when he gives them a diagnosis. “It really boils down to communica-
tion,” he said.
Understanding each patient’s culture plays a large role, as does knowing most patients will not make major health care decisions in a doctor’s office but at home with their families, he says.
Health literacy tools
Physicians and nurses can use certain tools to screen patients quickly for health illiteracy. The Newest Vital Sign (NVS) is a screening tool developed by a team of professors and physi- cians to quickly evaluate a patient’s level of understanding. According to “Quick Assessment of Literacy in Primary Care:
The Newest Vital Sign,” a 2005 study published in the Annals of Family Medicine, NVS is quicker than other literacy screening tools and is available in English and Spanish. Using NVS, a physician or nurse presents patients with a
health-related scenario, then asks questions about the scenario to prove their understanding of the information. For example, a nurse using NVS might give a patient a nutrition label from an ice cream container, then ask six questions about the label, such as “If you eat the entire container, how many calories will you eat?” According to the report, the average test takes three min-
utes. Download the free NVS toolkit from the Pfizer website,
www.pfizer.com/health/literacy. Other health literacy tests specialize in specific areas of health, such as diabetes, nutrition, and dental care. The North Carolina Program on Health Literacy offers several online tests,
http://nchealthliteracy.org/instruments.html.
48 TEXAS MEDICINE July 2014
“It may be fear of the setting. It may be fear they have a health problem, and they don’t want to come to terms with it,” he said. “It might not be until later that they come to terms with what the health issues are and think about ques- tions they should have asked.” Dr. Shah says the solution is as easy as taking a few extra minutes to make sure the patient understands what’s go- ing on. He says physicians need to real- ize a concept that is simple to them is not always easy for a patient to grasp. Physicians should sit patients down, look them in the eye, and really try to make sure they understand the health concern, he says. Dr. Shah recently took the position of emergency department medical director at Resolute Health in New Braunfels. He says health literacy promotion is a major mission there. Resolute Health not only acts as a hospital but also offers wellness pro- grams for the community, from training patients to manage their diabetes to of- fering nutrition therapy classes. Resolute Health also houses a fitness center, of- fers interactive cooking classes, and em- ploys a bilingual staff. Dr. Shah says the organization helps patients understand health care by creat- ing a unified network of health care pro- fessionals so the patients’ social workers, specialists, and physicians can collabo- rate to ensure patients understand their health needs.
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