Table 5.
Health literacy practices for health professionals: Consensus group ratings (N = 23)
| Item | Source example | Very appropriate or appropriate (%) | Very important or important (%) | Round accepted | |
|---|---|---|---|---|---|
| The individual… | |||||
| P1 | … consistently elicits the full list of patient concerns at the outset of encounters. | Osborne, 2005 | 89.5 | 79.0 | 1 |
| P2 | … consistently negotiates a mutual agenda with patients at the outset of encounters. | Osborne, 2005 | 94.7 | 89.4 | 1 |
| P3 | … routinely recommends the use of professional medical interpreter services for patients whose preferred language is other than English. | Andrulis & Brach, 2007 | 94.7 | 94.8 | 1 |
| P4 | … consistently speaks slowly and clearly with patients. | Weiss, 2007 | 100 | 94.7 | 1 |
| P5 | … routinely uses verbal and non-verbal active listening techniques when speaking with patients. | Osborne, 2005 | 100 | 94.7 | 1 |
| P6 | When preparing to educate patients, routinely asks about patients' preferred learning style in a non-shaming manner (e.g., asks, “What is the best way for you to learn new information?”). | The Joint Commission, 2007 | 72.7 | 71.4 | 2 |
| P7 | … routinely elicits patients' prior understanding of their health issues in a non-shaming manner (e.g., asks, “What do you already know about high blood pressure?”). | Doak et al., 1996 | 89.5 | 79.0 | 1 |
| P8 | … routinely puts information into context by using subject headings in both written and oral communication with patients. | AMA Foundation, 2007 | 90.9 | 86.3 | 2 |
| P9 | … routinely uses short action-oriented statements, which focus on answering the patient's question, “what do I need to do” in oral and written communication with patients. | Oates & Paasche-Orlow, 2009 | 94.5 | 70.5 | 1 |
| P10 | … routinely emphasizes one to three “need-to-know” or “need-to-do” concepts during a given patient encounter. | Sheridan et at, 2011 | 88.3 | 82.4 | 1 |
| P11 | … routinely uses analogies and examples, avoiding idioms and metaphors, to help make oral and written information more meaningful to patients. | Doak et al., 1996 | 86.3 | 76.2 | 2 |
| P12 | … routinely selects culturally and socially appropriate and relevant visual aids, including objects and models, to enhance and reinforce oral and written communication with patients. | Doak et al., 1996 | 94.5 | 94.4 | 1 |
| P13 | … routinely makes instructions interactive, such that patients engage the information, to facilitate retention and recall. | Doak et al., 1996 | 88.8 | 88.9 | 1 |
| P14 | … consistently avoids using medical jargon in oral and written communication with patients, and defines unavoidable jargon in lay terms.* | Weiss, 2007 | 94.8 | 100 | 1 |
| P15 | … consistently follows principles of easy-to-read formatting when writing for patients, including the use of short sentences and paragraphs, and the use of bulleted lists rather than denser blocks of text, when appropriate. | CMS, 2013 | 89.5 | 84.3 | 1 |
| P16 | … routinely writes in English at approximately the 5th–6th-grade reading level. | AMA Foundation, 2007 | 88.9 | 78.9 | 1 |
| P17 | … consistently writes or re-writes (“translates”) unambiguous medication instructions when called for during regular duties. | Sheridan et at, 2011 | 88.9 | 83.4 | 1 |
| P18 | … routinely conveys numeric information, such as risk, using low numeracy approaches, such as through examples, in oral and written communication.* | Osborne, 2005 | 89.4 | 78.9 | 1 |
| P19 | … consistently uses a universal precautions approach to oral and written communication with patients.* | DeWalt et al., 2010 | 83.3 | 83.3 | 1 |
| P20 | … routinely conducts medication reconciliation with patients, including use of “brown bag” medication reviews, when called for during regular duties. | AMA Foundation, 2007 | 84.2 | 73.7 | 1 |
| P21 | … routinely encourages and facilitates patients to carry an updated list of their medications with them. | The Joint Commission, 2007 | 100 | 94.5 | 1 |
| P22 | … routinely assesses adherence to treatment recommendations, and root causes for non-adherence, non-judgmentally, before recommending changes to treatment plans. | AMA Foundation, 2007 | 100 | 94.7 | 1 |
| P23 | … consistently elicits questions from patients through a “patient-centered” approach (e.g., “What questions do you have?” rather than “Do you have any questions?” | Oates & Paasche-Orlow, 2009 | 94.7 | 84.2 | 1 |
| P24 | … routinely anticipates and addresses navigational barriers within health care systems and shares responsibility with patients for understanding and navigating systems and processes; attempts to make systems and processes as transparent as possible. | Rudd & Anderson, 2006 | 83.3 | 84.2 | 1 |
| P25 | … routinely ensures that patients understand at minimum: 1) what their main problem is, 2) what is recommended that they do about it, and 3) why this is important. | National Patient Safety Foundation, 2010 | 100 | 89.5 | 1 |
| P26 | … consistently locates and uses literacy-appropriate patient education materials, when needed and available, to reinforce oral communication, and reviews such materials with patients, underlining or highlighting key information. | Berkman et al., 2004 | 88.9 | 94.5 | 1 |
| P27 | … routinely “chunks and checks” by giving patients small amounts of information and checking for understanding before moving to new information. | AMA Foundation, 2007 | 89.5 | 84.2 | 1 |
| P28 | … routinely uses a teach back or “show me” technique to check for understanding and correct misunderstandings in a variety of health care settings, including during the informed consent process.* | Schillinger et al., 2003; The Joint Commission, 2007 | 100 | 94.4 | 1 |
| P29 | … consistently treats the diagnosis of limited health literacy as “protected health information” requiring specific “release of information” for disclosure. | Consensus group participants | 72.7 | 72.7 | 2 |
| P30 | … routinely arranges for timely follow-up when communication errors are anticipated. | Weiss, 2007 | 83.3 | 72.3 | 1 |
| P31 | … routinely refers patients to appropriate community resources for enhancing literacy and/or health literacy skills (e.g., Adult Basic Literacy Education) within the context of the therapeutic relationship. | AMA Foundation, 2007 | 77.8 | 72.2 | 1 |
| P32 | … routinely documents in the medical record that a teach back, or closed communication looptechnique has been used to check the patient's level of understanding at the end of the encounter.* | Weiss, 2007 | 91.5 | 86.4 | 3 |
| Practice item that did not achieve consensus after four rounds | |||||
| The graduate … | |||||
| Px | … consistently limits the use of words with three or more syllables in oral and written communication. | AMA Foundation, 2007 | 59.1 | 54.5 | No consensus |
Note. Twenty-three panelists participated in Round 1; 22 panelists participated in subsequent rounds.
*
See Appendix.