Alabama Hospital Association Addresses Health Literacy

Rosemary Blackmon

"In order to improve health care, patients have to understand what you are telling them to do," said Rosemary Blackmon, executive vice president and chief operating officer of the Alabama Hospital Association (AlaHA).

It may seem like that goes without saying, but Blackmon said too many providers use big words and acronyms to describe problems and many patients simply don't understand or retain the information. The AlaHA has sponsored a health literacy program at one of their regional meetings in an effort to teach clinicians to speak in ways their lay patients can relate to and to teach methods ensuring they've communicated accurately.

Several years ago a health literacy coalition was formed that included the AlaHA, UAB's advanced practice nurse program, Blue Cross, physicians, pharmacists and representatives from the Samford University Allied Health program to develop ways for patients to understand better their medical instructions and the care they were getting.

Blackmon said the coalition learned about research that showed that even some college graduates couldn't do fractions. "Think about how often you may tell someone to take a fourth of a pill," she said.

In other cases, the solution is simply to use language better understood to the lay public, such as high blood pressure rather than hypertension.

One method Blackmon recommends is the teach-back method. After practitioners tell patients what they need to know and what they need to do, the patient is asked to repeat the information, or teach it back. That way the practitioner can see where the gaps of knowledge are.

Blackmon said that, as part of the literacy program, nursing students analyzed hospital brochures, instructions and discard kits. They helped edit them down to a sixth grade reading level so they were understandable. "Some of this literature is way over everyone's head," she said. "How do you take that information and make sure it's understandable? That was also good practice for the nursing students."

The coalition developed a train-the-trainer program to help spread the information to institutions across the state. "We created the program for hospitals, but we even had Birmingham firefighters participate," Blackmon said.

Some of the training videos showed patients talking about their care or explaining their condition to their children. "You don't really get how important this is until you watch these videos and see they aren't getting it," she said.

Participants in the training were given a toolkit to take back to their institution to share the information with coworkers. "The idea of train-the-trainer is exponential growth," said Margaret Borders, AlaHA quality director. "You train a certain number of people with you, and when they go back, they train more people to implement at their hospital."

Health literacy skills
From the Centers for Disease Control and Prevention Website

Anyone who needs health information and services also needs health literacy skills to:

  • Find information and services;
  • Communicate their needs and preferences and respond to information and services;
  • Process the meaning and usefulness of the information and services;
  • Understand the choices, consequences and context of the information and services;
  • Decide which information and services match their needs and preferences so they can act;

Anyone who provides health information and services to others, such as a doctor, nurse, dentist, pharmacist, or public health worker, also needs health literacy skills to:

  • Help people find information and services;
  • Communicate about health and healthcare;
  • Process what people are explicitly and implicitly asking for;
  • Understand how to provide useful information and services;
  • Decide which information and services work best for different situations and people so they can act;


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Alabama Hospital Association; Rosemary Blackmon; Margaret Borders; health litera


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