Transcript Literacy in Adult Population

Literacy in Adult Population
Dr. Belal M. Hijji, RN, PhD
April 17, 2012
Learning Outcomes
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Define some of concepts relevant to literacy
Discuss clues indicating patient illiteracy
Describe the impact of illiteracy on compliance and motivation
Examine strategies that an educator should follow in teaching
low-literacy patients
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Definition of Terms
• Literacy: Is an umbrella term used to describe socially required
and expected reading and writing abilities.
• Health literacy: Refers to how well an individual can read,
interpret, and comprehend health information for maintaining
an optimal level of wellness.
• Low literacy: Refers to the ability of adults to read, write, and
comprehend information between the fifth and eighth-grade
level of difficulty.
• Functional literacy: Refers to the ability to read, write, and
comprehend information below the fifth-grade level.
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Assessment of Patient Literacy
• Identifying illiteracy is not easy because it has no particular
face, age, socioeconomic status, or nationality.
• Nurses are in ideal position to determine the literacy level of
their patients.
• Because illiteracy is prevalent, nurses should never assume
that their patients are literate.
• Nurses need to know a patient’s ability to read and
comprehend as this is critical in providing teaching-learning
encounters that are useful and effective.
• There are a number of informal clues to look for that indicate
reading and writing deficiencies. These are:
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– Reacting to complex learning situations by withdrawal or
complete avoidance.
– Using the excuse that they were too busy or too tired.
– Claiming that they did not feel like reading or that they lost their
glasses.
– Camouflaging their problem by surrounding themselves by load
of books or magazines.
– Circumventing [‫ ]يتغلب بالمراوغة‬their inability by insisting on
taking the information home to read or having a family member
with them when written information is presented.
– Asking someone to read as they “are not interested”.
– Listening and watching very attentively to observe and
memorize how things work.
– Failing to ask any questions about the information they received.
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Impact of Illiteracy on Motivation and Compliance
• Poor literacy skills affect the ability to read, understand and
interpret the meaning of written, visual, and verbal instructions
• Poor reading skills result in difficulty in analysing instructions,
assimilating and correlating new information, and formulating
questions. For example, a patient who ingested a suppository
orally because she was not able to read the word!
• Illiterate clients have difficulty synthesising information in a
way that fits into their behaviour pattern. If they can’t
comprehend a required behaviour change or can’t understand
why it is needed, then any health teaching will be disregarded.
For example, a cardiac patient who received verbal and written
information to lose weight, increase exercise, decrease fat
intake, and take medication may fail to comply with this
regimen because of lack of understanding of the information
and how to incorporate these changes into lifestyle.
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• A limitation in people with poor literacy skills is that they
think in only concrete, specific, and literal terms. An example
is a patient whose glucose levels were out of control even
when he insisted that he was taking insulin as instructed –
injecting the orange and then eating the fruit!
• Poor literacy skills is responsible for the failure of patients to
handle a large amount of information and classifying it into
categories. Patients ordered several medications to be taken at
various times and in different dosages may become confused
with the schedule or noncompliant.
• Poor literacy skills tend to limit the patient’s ability to
understand the array of instructions regarding medication
labels, dosage scheduling, and side effects.
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Teaching Strategies for Low-Literate Patients
• Teaching patients with poor reading skills needs to be viewed
as a challenge rather than a problem.
• Teaching methods and tools need to meet the logic, language,
and experience of the patient who has difficulty in reading or
understanding.
• The following strategies are suggested to for nurse educators
to use:
– Establish a trusting relationship before beginning the teachinglearning process.
– Use the smallest amount of information possible to accomplish
the predetermined behavioural objectives. Stick to the essentials,
paring down what the information you teach to what the must
learn.
– Make points of information as vivid [clear, very bright] and explicit as
possible. Explain information in simple terms, using everyday
language. For example, a sign reading “NOTHING BY MOUTH’, or
“NPO” should be changed to “Do Not Eat or Drink Anything”.
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– Teach one step at a time. Teaching in increments and organising
information into chunks [pieces] help to reduce anxiety and
confusion and give enough time to patients to understand each
item before proceeding to the next unit of information.
– Use teaching methods and tools requiring fewer literacy skills.
Oral instruction contains cues such as tone, gestures, and
expressions that are not found in written materials. However, a
spoken word lacks punctuation and capital letters. Therefore, a
patient with poor reading skills may have difficulty with
understanding the spoken language and with reading.
– Allow patients the chance to restate information in their own
words and to demonstrate any procedures being taught.
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– Keep motivation high. An illiterate patient may feel like failure
when he is unable to work through a problem. Reassure him that
that it is normal to have trouble with new information and that he
is doing well, and encourage him to keep trying.
– Build in coordination of procedures. Simplify information by
using the principles of tailoring and cuing to facilitate learning.
Tailoring means to coordinate or incorporate a patient’s regimen
into his daily schedule rather than forcing him to adjust lifestyle
to a regimen imposed on him. For example, incorporating a
medication schedule to a patient’s mealtime does not drastically
alter his lifestyle and increase motivation. Cuing focuses on the
appropriate combination of time and situation using reminders to
get a person to do routine tasks. For example, placing
medications where they best can be seen on a frequent basis or
keeping a simple chart to check off each time a drug is taken.
– Use repetition to reinforce information.
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