| 1. Be informed about health literacy and recognize it (27; 61.4) |
Learn about health literacy and ways to integrate it into practice (1, 9, 43, 44) Do not assume that all clients understand what they are told (9) even if they nod their head (3) or that they can read (36, 47) Recognize the powerlessness (5), shame and sense of failure that some people may feel (47) Identify your client’s characteristics [knowledge, teaching preferences (3), skills, beliefs, culture, barriers, etc. (46, 64)]
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| 2. Standardize practice to health literacy (10; 22.7) |
Develop professional standards (9) and position statements for health communications and interactions Include health literacy criteria into quality and accreditation standards of health care organizations (17)
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| 3. Consider health literacy by making information accessible (37; 84.1) |
Adapt the information to individual needs, circumstances and abilities to show how it is relevant (5, 11, 46, 64) Design written information: 1) in the active voice [the way you talk (3)]; 2) with clear simple language [use common short words and short sentences; avoid technical terms, value judgment words, jargon, abbreviations and acronyms; give examples to explain difficult words; use the same words throughout the material (3)]; 3) with pictures or drawings (13, 26, 30, 35, 44, 46) to illustrate procedures such as exercises or activities; 4) interactive and with recaps; and 5) with the most important information placed first; and 6) personalize the information (46) Communicate in a comprehensive way using more than one way of exchanging information (46, 64) Combine oral instructions with written information (in clear simple language) for future reference (32) and with a lot of demonstrations including audiovisual aids (46) Communicate effectively (1, 4, 23, 24) and simply in an atmosphere conducive to communication (55): 1) announce the subject, 2) convey the message, and 3) ask clients to say in their own words what they remember of the information or methods taught (3, 7, 9, 25, 32, 46, 47). This ‘teach-back’ technique provides opportunities to identify misunderstandings and correct them (3, 46) Use the Ask Me 3 – Clinical version by asking the client the following questions: 1) What is your main problem today? 2) What do I need to do for you concerning this problem? 3) Why is it important to you? (3) Help clients make optimal use of health services (2, 10, 11) Increase the quality of professionals’ communications (7) and associated professional competencies (5) Use anecdotal information from everyday life presented as personal stories (31, 64) Do not overburden clients with information or recommendations (47); select only a few key points that are most important clinically (24, 34) Use a structured educational approach (including appraisal of clients’ perceptions and identification of affective aspects and barriers to change) in order to understand what motivates clients and personalize the treatment plan (3, 47)
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| 4. Strengthen interactions (26; 59.1) |
Encourage clients to ask questions (7, 9) Take an understanding attitude (do not blame) (5) and create a “shame free” safe environment (46) Increase the time spent on giving information (speak more slowly and repeat if necessary), observe and listen actively (3, 24) [stay quiet to give clients time to organize their thoughts, identify their constraints and formulate questions (47)] Increase one’s cultural competency (5), i.e. be a professional who respects differences, is open to learning and is willing to admit there is more than one way to look at the world Follow up on interventions (44, 46) to see if recommendations have been followed and if clients have questions Involve not only the client, but also families and other stakeholders in treatment (46, 47)
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| 5. Intervene to increase client’s health literacy (29; 65.9) |
Optimize client’s reading and writing skills (2, 9, 10, 65) including use of the Internet (46) Teach (7): increase clients’ knowledge of health and its determinants (5, 13) and what they can do to improve their living conditions (46) Encourage clients to read every day (9) and if necessary take a local literacy program (66) Foster empowerment by using a client-centered approach (31, 46) and giving clients confidence (7) in their ability to take more control over their lives. This empowerment includes making them responsible for taking care of their health, making decisions about their health and being truly engaged in their care (3, 5, 9, 11), and helping them identify ways to do this (47), using for example The Teach to Goal method where the client chooses a goal and the staff helps the client develop steps to reach the goal (3)
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| 6. Collaborate to increase clients’ health literacy (21; 47.7) |
Participate in intersectoral activities that brings all the sectors together (1, 7, 9, 11, 14, 43), policy development (2, 9) and research (1, 2, 7, 9, 37) on health literacy Provide education to other health care professionals about health literacy topics (3)
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