“The single biggest problem with communication is the illusion that it has taken place” George Bernard Shaw
What is the reading age of the most popular newspaper in Scotland, The Sun?
If you were to categorise it and place it on a shelf where would you put it? 8-10 yrs? 12-14? 14-16 yrs? The answer is 8 years old.
In terms of language level, vocabulary, grammar etc. The Sun is written at the same level as a school reading book for an eight year old child. According to The Literacy Trust the average reading age in Scotland is only 9 years old. This sort of information has massive implications for the way we communicate with our patients, carers, their friends and family. If we are producing written material or talking in a way that is too technical, medical or wordy we lose, bewilder and alienate our audience whilst thinking we have been clear. It is referred to as health literacy – the gap between what we as professionals think we have said and what our patients have actually heard or understood or are able to access. It brings to mind the confusion in the classic Two Ronnie’s sketch where a man walks into a hardware shop and asks for Fork Handles and receives 4 candles!
October is World Health Literacy Month and the aim is to raise awareness of this gap in communication. The Health Literacy Place is a website attached to The Knowledge Network and details the Making It Easy action plan to improve Health Literacy here in Scotland. It contains some frightening statistics:
- 43% of English working age adults will struggle to understand the instructions to calculate a childhood paracetamol dose
- 26% of people in Scotland have occasional difficulties with day to day reading and numeracy
- People with lower health literacy have increased rates of emergency admissions, wait until they are sicker before visiting their GP and are less likely to engage with public health programmes eg breast screening and vaccination
- In general people remember and understand less than half of what we discuss with them
The implications for patient experience, safety and access to services are clear. This is not just a welfare or financial obligation, but a legal one. The Patient Rights (Scotland) Act 2011 states that “people should be communicated with in a way that they can understand and that healthcare staff should make sure that the patient has understood the information given.” Our skill as healthcare professionals is not only to diagnose and treat but to communicate those findings in a culturally appropriate, meaningful and memorable way.
Here in D&G it has never been more timely for us to think about these issues as we plan our own Big Move, thinking about clear signage, systems for patient appointments, e-records etc in our new home. In addition our English neighbours in Cumbria are getting to grips with the Accessible Information Standards. These legal standards were introduced into NHS England on 31st July this year and go one step further in addressing communication needs. They stipulate that a person with a disability, impairment or sensory loss should be provided with information that they can easily read or understand with support. The Standards also state that these needs should be identified and recorded prior to a patient accessing a service.
The good news is that because of the introduction of these standards in England there are lots of resources to help us look at our practice here in Scotland. So where do we start? As a communication specialist, it’s a subject close to my heart.
If you are looking at a service audit or improvements, some handy hints include:
- to never be without a pen and paper
- to download a profession specific app or animated sequence for your phone or tablet
- sit down or be at eye level for all conversations, where possible
- order a name tag and say..”Hellomynameis…”
- attend one of the specialist workshops in the Education Centre
“Tell me your story…”
Asking this initial interview question allows you time to tune in like a radio to the person’s wavelength. By asking this I can assess fluency, coherence, intelligibility, cognitive ability, word finding skills, language level and most importantly adjust mine accordingly .. but also assess the patient’s accuracy as a historian, their interpretation of events, what they believe the doctor said, if there’s an outstanding or unresolved issue or complaint, their mood and motivation for engaging with therapy, what is important to them, their family, goals, hobbies and start to identify any hooks that I can hang my therapy on to make it personal and meaningful and therefore increase its success. Not bad for one simple question!
Perform the SMOG!
The simplified measure of gobbledygook – yes it’s a real thing. Created in 1969, take any piece of written material your service routinely supplies and apply the formula to calculate a reading age. If it’s higher than 9, think again. http://prevention.sph.sc.edu/tools/SMOG.pdf
Access The Health Literacy Place
This NES website gives some really great tailored resources for GPs and medics, AHPs and nurses including simple techniques like Teachback, but also online courses, training and templates to re-evaluate and improve your communication personally and within your service. http://www.healthliteracyplace.org.uk/media/1360/health-literacy-month-eflyer-2.pdf
Chat to a friendly Speech & Language Therapist
But then I would say that! The Royal College has a new position paper and website to support Health Literacy or Inclusive Communication as it’s sometimes known.
…for a chortle and a lighter look at Health Literacy as seen from the perspective of the doctor we all love to hate, click or paste the link below…. If you can’t see it you may need to upgrade your version of Internet Explorer to 11. http://www.youtube.com/watch?v=zG2DVoRP86g
Happy Friday and happy Health Literacy Month!
Helen Moores is a Specialist Speech and Language Therapist for Adult Service & The IDEAS Team (Interventions for Dementia, Education, Assessment & Support) at NHS D&G
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Health Literacy Month logo and Health Literacy Heroes illustration are reprinted with permission of Helen Osborne, founder of Health Literacy Month